Predictive factors of liver injury in blunt multiple trauma

Introduction This study was conducted to clarify whether injuries that are likely to be revealed by initial clinical and conventional radiological examination at the trauma bay (e.g., right-side rib fractures) meaningfully contribute to the prior probability of accompanying hepatic lesions in multiple injured patients.Material and methods Fifty-five subjects (sampled from a cohort of 218 patients) with liver injury fulfilling the definition of polytrauma were compared with 55 polytrauma patients without liver injury. Controls were individually matched for age, gender, and Injury Severity Scores. Whole-body, helical, contrast-enhanced computed tomography was applied to all participants. We modeled independent predictors of liver involvement by conditional logistic and random-effects regression analysis.Results In the present sample, the prevalence of hepatic injury was 25.2%. Neither the injury mechanism (car crash, pedestrian accident, fall from height) nor certain accompanying injuries (right-side serial rib fractures, lumbar spine fractures) predicted the presence of hepatic injury. Liver injury was particularly unlikely in bikers [odds ratio (OR) 0.78, 95% confidence interval (CI) 0.59–1.03] and patients with left-side rib fractures (OR 0.80, 95% CI 0.66–0.98).Discussion There are no index injuries that will reliably indicate the presence of liver involvement in multiple trauma cases. Also, the absence of these injuries cannot rule out liver damage.G. Matthes and D. Stengel contributed equally to this work.     

Patterns of accidental genital trauma in young girls and indications for operative management

Background/purpose

The aim of this study was to define the injury patterns of accidental genital trauma (AGT) in female patients and examine the indications and outcomes of operative intervention.

Methods

Review of patients younger than 16 years with AGT from 1980 to 2007 excluding sexual- and obstetric-related injuries.

Results

One hundred sixty-seven patients met the criteria. Mean (±SEM) age was 6.9 (0.2) years. There were 70.5% straddle injuries, followed by nonstraddle blunt injuries (23.5%) and penetrating injuries (6.0%). Injuries to the labia were most frequent (64.0%). Injuries to the posterior fourchette (7.8%) and hymenal disruption (8.4%) were less frequent. There was 87.9% of AGT that was managed expectantly without further sequelae. Twenty patients (12.1%) were managed operatively. Penetrating injuries were more likely to require operative management (P ≤ .03). The operative group was also more likely to have multiple genital injuries (60% versus 25%, P < .01). Proctoscopy, vaginoscopy, and/or cystoscopy were performed in 55% of patients in the operative group.

Conclusions

Accidental genital trauma is most commonly caused by straddle-type injuries and is usually amenable to nonoperative management. Hymenal disruption and injuries to the posterior fourchette are uncommon with these types of injuries.     

Does the severity of spontaneous genital tract trauma affect postpartum pelvic floor function?

We describe the impact of genital trauma on pelvic floor function in a low-risk cohort of women after vaginal birth. Questionnaires (Present Pain Intensity Scale, Incontinence Impact Questionnaire, Fecal Incontinence Score, and Intimate Relationship Scale) were completed up to 12 weeks postpartum. Severity of trauma was recorded at delivery. Overall follow-up was 444/565 (79%). Major trauma (trauma that involved perineal muscles or required suturing) occurred in 20%; 20% delivered intact. At 12 weeks, 10% complained of perineal pain; 24% reported anal (AI) and 27% urinary incontinence (UI). Women with trauma were no more likely than those intact to complain of UI or AI, sexual inactivity, or perineal pain postpartum (all P = NS). Women with major trauma had weaker pelvic floor exercise strength than those who delivered intact or with minor trauma (odds ration 3.06, 95% confidence interval 1.41–6.63). Pelvic floor complaints postpartum were common but not associated with severity of genital trauma in a cohort of low-risk women.     

The impact of injuries below the knee joint on the long-term functional outcome following polytrauma

Previous studies have suggested that the lower-extremities are among the most frequently injured body regions in polytrauma patients and have a major impact on the functional recovery following polytrauma. In particular, injuries to the distal part of the lower-extremity appear to be associated with a poor functional outcome. Therefore, the goal of this study was to evaluate the impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Three hundred eighty-nine polytrauma patients with associated lower-extremity fractures and a minimum follow-up of 10 years were included in this study. All patients were examined by a doctor, using a patient questionnaire and a standardised physical examination. Significantly, inferior outcomes were seen in patients with fractures below the knee joint as measured by the modified Karlstr?m-Olerud score, Lysholm score, range of motion, weight bearing status, Hannover score for polytrauma outcome (HASPOC), SF-12, Tegner activity score, and inability to work (P < 0.05). Fractures below the knee joint have a significant impact on the functional recovery following polytrauma. We suggest that delayed treatment, thin soft tissue envelope below the knee joint, high-energy trauma, unfavorable blood supply, and complex fracture patterns contribute to these unfavorable outcomes.     

The continuing challenge of female genital mutilation in Sudan

ObjectivesTo evaluate the frequency of female genital mutilation (FGM) among Sudanese women in comparison to other African countries. To review the immediate and the late complications of FGM. To suggest possible ways of its prevention and eradication.Subjects and methodsThis is a retrospective cross sectional study involving two groups of Sudanese women. The first group which comprises 1200 women was university students and this group represents nearly all parts of the Sudan as University students come from different ethnic and cultural groups. The second group which included 800 women was selected as a sample of women coming to the outpatient Urology clinic of Soba University Hospital in Khartoum, which is a tertiary referral hospital, seeking medical advice for different urological problems. All the two groups signed consent to be part of this study. All patients in group A were given a written questionnaire including all the information's about their experience with FGM to answer.ResultsOut of the 2000 women who were included in this study, 1468 were victims of FGM. Their ages ranged between 20 and 62 with a mean age of 46 years. The FGM was performed below the age of six year in 1423 (96.9%). It was performed by a midwife at home set up in 1416 (94.5%). There were 267 immediate complications and 618 late complications. The most serious complications were bleeding, sepsis and vesico-vaginal fistula. Other complications are discussed.     

The impact of non-thermal injuries in combined burn trauma: A retrospective analysis over the past 35 years

Introduction

Combined burn trauma is rather uncommon and frequently difficult to manage. Historically combined burn trauma contributed to high mortality rates in severely injured patients. The purpose of this study was to determine the incidence, mechanisms and impact of non-thermal injuries in patients with severe burns.

The impact of trauma mechanism on outcome: a follow-up study on health-related quality of life after major trauma

Objectives  

To relate the trauma mechanism in a trauma population to health-related quality of life outcomes and mortality rates.     

Association of cutis laxa and genital prolapse: a case report

Cutis laxa (CL) is an extremely inherited or acquired connective tissue disorder characterised by a markedly reduced systemic elastin content. Genital abnormalities in patients with CL have been rarely reported. We report such a case in a 48-year-old CL patient affected by genital prolapse, focusing on immunohistological and molecular biology assessment of elastin and collagen type I, III, VI content in the main uterine ligaments. The woman was referred to our department for the onset of a rapidly progressing genital prolapse and urinary incontinence. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and sacrocolpopexy. Punch biopsies from both cardinal and uterosacral ligaments revealed a dramatic reduction in elastin and an increase in collagen type VI content. The present report seems to underline the central role exerted primarily by elastin in the supportive connective tissue and might contribute to the knowledge of extracellular matrix abnormalities at the basis of genital abnormalities in CL patients.     

The impact of cystic fibrosis on recovery from orthopedic trauma: A case study

Cystic Fibrosis has effects on many body systems, including the skeletal system. In this case, we describe the impact of respiratory and endocrine disease on bone healing following orthopedic trauma in a 22-year-old woman. Limitations to mobility resulting from trauma complicated her respiratory condition. Disease-related effects on bone health and healing delayed her recovery from the trauma. It is important to recognize the multisystemic nature of CF, even when managing acute orthopedic injuries.     

The unstable thoracic cage injury: The concomitant sternal fracture indicates a severe thoracic spine fracture

IntroductionThe thoracic cage is an anatomical entity composed of the upper thoracic spine, the ribs and the sternum. The aims of this study were primarily to analyse the combined injury pattern of thoracic cage injuries and secondarily to evaluate associated injuries, trauma mechanism, and clinical outcome. We hypothesized that the sternal fracture is frequently associated with an unstable fracture of the thoracic spine and that it may be an indicator for unstable thoracic cage injuries.Patients and methodsInclusion criteria for the study were (a) sternal fracture and concomitant thoracic spine fracture, (b) ISS ≥ 16, (c) age under 50 years, (d) presence of a whole body computed-tomography performed at admission of the patient to the hospital. Inclusion criteria for the control group were as follows: (a) thoracic spine fracture without concomitant sternal fracture, (b)–(d) same as study cohort.ResultsIn a 10-year-period, 64 patients treated with a thoracic cage injury met inclusion criteria. 122 patients were included into the control cohort. In patients with a concomitant sternal fracture, a highly unstable fracture (AO/OTA type B or C) of the thoracic spine was detected in 62.5% and therefore, it was significantly more frequent compared to the control group (36.1%). If in patients with a thoracic cage injury sternal fracture and T1–T12 fracture were located in the same segment, a rotationally unstable type C fracture was observed more frequently. The displacement of the sternal fracture did not influence the severity of the concomitant T1–T12 fracture.ConclusionsThe concomitant sternal fracture is an indicator for an unstable burst fracture, type B or C fracture of the thoracic spine, which requires surgical stabilization. If sternal and thoracic spine fractures are located in the same segment, a highly rotationally unstable type C fracture has to be expected.     

Transfer of facially injured road trauma victims and its impact on treatment

BACKGROUND: Road trauma is a common cause of severe facial injuries. The aim of the present study is to define patients involved, and determine the effect of their geographical origin on treatment and follow up. METHODS: All patients over 14 years of age suffering facial injuries caused by road trauma presenting to the two study hospitals from 1994 to 1999 were identified and details were collected on demographic details and treatment. RESULTS: Four hundred and nine patients met the inclusion criteria. The majority required hospital transfer. Young men were the most frequently injured group of patients. Patients from peripheral regions had significant delays in transfer and treatment. They were made fewer outpatient appointments but attended at the same frequency as patients from the immediate region of the study hospitals. CONCLUSIONS: To minimize delays the process of patient transfer needs to be streamlined and education of staff in peripheral hospitals undertaken regarding facial injuries.     

The effect of neoadjuvant chemotherapy and surgery in children with malignant germ cell tumors of the genital region: a pediatric intergroup trial

Purpose

This study was designed to evaluate (1) the efficacy of standard or high-dose cisplatin with etoposide and bleomycin and (2) the role of surgical resection in infants and children with malignant germ cell tumors (MGCT) of the genital region.

Methods

Fourteen of 317 children enrolled in to the Pediatric Oncology Group/Children’s Cancer Group intergroup study of MGCT from 1990 through 1996 had genital tumors. Thirteen were eligible for inclusion (12 vaginal, one penile). The initial procedure was biopsy in 11 and subtotal resection in 2. Patients were assigned randomly to receive 4 cycles of etoposide, bleomycin, and either standard or high-dose cisplatin.

Results

Nine children underwent postchemotherapy excision of the residual site, and 2 had subsequent biopsies to confirm a complete response. Two with relapse were saved with additional therapy, and one with progressive disease died. The 4-year event-free survival rate in these patients is 76.2% ± 13.1%, and 4-year survival rate is 91.7% ± 8.4%.

Conclusions

The author conclude that: (1) the current survival rate for genital MGCT is excellent, (2) delayed surgical resection with organ preservation is not associated with an adverse outcome, and (3) the treatment comparison of the effect of cisplatin dose was inconclusive in this small study population.     

The risk of postoperative urinary incontinence after surgical treatment of genital prolapse

Full urodynamic assessment, including urethral profiles at rest and under stress, was made before and after surgery for severe urogenital prolapse in 40 continent women. Profilometry was also recorded after reduction of the prolapse by a vaginal pessary. The aim of this study was to try to determine criteria to prevent postoperative incontinence. After surgery, 6 patients (15%) became stress incontinent. The operation tends to diminish urethral obstruction (diminution of the residual volume) and negatively affects urodynamic urethral parameters (diminution of the residual continence area). The pessary test was not predictive of postoperative incontinence. Preoperative transmission ratio <100% and/or maximum urethral closure pressure <35 cmH₂O are proposed as predisposing factors for postoperative iatrogenic incontinence. Therapeutic implications are discussed.     

The surgical management of facial trauma in British soldiers during combat operations in Afghanistan

IntroductionThe recent Afghanistan conflict caused a higher proportion of casualties with facial injuries due to both the increasing effectiveness of combat body armour and the insurgent use of the improvised explosive device (IED). The aim of this study was to describe all injuries to the face sustained by UK service personnel from blast or gunshot wounds during the highest intensity period of combat operations in Afghanistan.MethodsHospital records and Joint Theatre Trauma Registry data were collected for all UK service personnel killed or wounded by blast and gunshot wounds in Afghanistan between 01 April 2006 and 01 March 2013.Results566 casualties were identified, 504 from blast and 52 from gunshot injuries. 75% of blast injury casualties survived and the IED was the most common mechanism of injury with the mid-face the most commonly affected facial region. In blast injuries a facial fracture was a significant marker for increased total injury severity score. A facial gunshot wound was fatal in 53% of cases. The majority of survivors required a single surgical procedure for the facial injury but further reconstruction was required in 156 of the 375 of survivors aero medically evacuated to the UK.ConclusionsThe presence and pattern of facial fractures was significantly different in survivors and fatalities, which may reflect the power of the blast that these cohorts were exposed to. The Anatomical Injury Scoring of the Injury Severity Scale was inadequate for determining the extent of soft tissue facial injuries and did not predict morbidity of the injury.     

Influence of genital heat stress on semen quality in humans

The concept that an elevation of testicular temperature results in impairment of spermatogenesis is widely accepted. Here, current knowledge concerning genital heat stress and its consequences in men is reviewed. Duration of sitting during work positively correlates with daytime scrotal temperatures and daytime scrotal temperature negatively correlates with semen quality. However, the assumed negative correlation between duration of sitting and semen quality could not be shown in the available studies. Fertility parameters of professional drivers with long periods of sitting in vehicles were impaired; however, for predominantly affected drivers of vans, trucks or industrial heavy machinery potential confounders have to be considered. Wearing tight fitting compared with loose-fitting underwear is associated with significantly higher scrotal temperatures. However, available observations suggesting a link between tight-fitting underwear or trousers and impaired semen quality are not convincing. Studies addressing professional exposure to high temperatures delivered conflicting results concerning fertility parameters. The postulated negative impact of sauna visits on semen quality is not sufficiently underlined by the available studies. Oligozoospermic men with a varicocele have significantly higher scrotal temperatures than normozoospermic men, and according to several studies varicocelectomy normalises scrotal temperatures. A further link has been reported between fever and deteriorated semen quality. Contraception via genital heat stress has been demonstrated using hot sitting baths or insulating suspensors. However, down-regulation of spermatogenesis is inconsistent and unsafe. On the other hand, scrotal and consecutively testicular cooling is able to improve semen quality.     

生殖道感染对未足月胎膜早破母婴围产结局的影响

目的：探讨生殖道感染对未足月胎膜早破（PPROM）母婴围产结局的影响。方法对150例未足月胎膜早破患者临床资料进行回顾性分析,按照生殖道感染情况分为感染组（95例）和未感染组（55例）,比较两组患者母婴围产期并发症发生率。结果未足月胎膜早破生殖道感染发生率63.3%（95/150）。感染组平均期待治疗时间（5.27±2.53）d短于未感染组（11.89±3.26）d,差异有统计学意义（P＜0.05）。感染组剖宫产率、绒毛膜羊膜炎发生率大于未感染组,差异具有统计学意义（P＜0.05）。感染组胎儿窘迫、新生儿窒息、新生儿死亡率均大于未感染组,差异具有统计学意义（P＜0.05）。两组产褥感染和新生儿感染率比较,差异无统计学意义（P＞0.05）。结论生殖道感染是导致未足月胎膜早破的主要因素,对生殖道感染的治疗可降低未足月胎膜早破的发生率,改善母婴围产结局。     

Pediatric genital burns: a 15-year retrospective analysis of outcomes at a level 1 burn center

Background/Purpose

Burns involving the genitalia and perineum are commonly seen in the context of extensive total body surface area (TBSA) burns and rarely as isolated injuries because of protection provided by the thighs and the abdomen. Genital burns usually result in extended hospital stays and are accompanied by severe morbidity and increased mortality.

Methods

A retrospective analysis of consecutive pediatric (<18 years) patients with burns involving the genitalia admitted to the Saint Barnabas Medical Center Level 1 Burn Unit from January 1, 1995, to December 31, 2009, was performed.

Results

One hundred sixty pediatric patients (8.3%) had a genital burn, including 105 patients younger than 5 years (65.6%) and 55 patients between 5 and 18 years (34.4%). Overall mean TBSA was 13.8% ± 16.8%, mean TBSA (genitalia) was 0.84% ± 0.25%, mean length of stay (LOS) was 11.9 ± 11.9 days, and mean burn intensive care unit LOS was 4.9 ± 9.7 days.

Conclusions

In patients younger than 5 years, a TBSA burn more than 10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (<5 years) are more often the victims of abuse, and prolonged LOS is the norm (>2 weeks). Patients 5 years or older are more often male and usually have a TBSA burn more than 15%.     

Paediatric medical trauma: The impact on parents of burn survivors

In order to identify parents at risk of developing ongoing psychological distress after their child has sustained a burn a greater understanding of paediatric medical trauma is required.     

先天性肾上腺皮质增生所致女性外生殖器男性化畸形的诊断与治疗

本文分析了先天性肾上腺皮质增生所致女性外生殖器男性化畸形32例。31例为21-羟化酶缺乏,1例为11-羟化酶缺乏。外生殖器男性化畸形按 Prader 标准分为5型。本文详细描述了5型的外观表现。32例中以Ⅱ与Ⅲ型最为多见。4例按男性长大,其中2例幼时检查后纠正为女性,另2例已成年,难于改变性别。准确诊断性别对此症十分重要。一旦确诊,需终身补充皮质激素,以抑制 ACTH过度分泌而导致雄激素过剩及糖和(或)盐皮质激素的不足。外生殖器男性化畸形需行阴蒂与阴道整形术。文章并介绍了手术时间与方法。治疗后随诊月经,4例自然初潮,15例用药后初潮。9例已婚,5例已妊娠分娩,婴儿均健康。