Archives of Trauma Research Archives of Trauma Research Arch Trauma Res http://www.archtrauma.com 2251-953X 2251-9599 10.5812/atr. en jalali 2018 1 22 gregorian 2018 1 22 2 2
en Boards and Committees Boards and Committees issue-information issue-information http://www.archtrauma.com/index.php?page=article&article_id=14897
en Table of Contents Table of Contents issue-information issue-information http://www.archtrauma.com/index.php?page=article&article_id=14899
en 10.5812/atr.13556 Approach to Trauma During Pregnancy Approach to Trauma During Pregnancy editorial editorial 61 62 http://www.archtrauma.com/index.php?page=article&article_id=13556 Masoumeh Abedzadeh-Kalahroudi Masoumeh Abedzadeh-Kalahroudi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615620634, Fax: +98-3615620634 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615620634, Fax: +98-3615620634
en 10.5812/atr.12501 Hepatic Ischemia and Reperfusion Injury and Trauma: Current Concepts Hepatic Ischemia and Reperfusion Injury and Trauma: Current Concepts review-article review-article Results

The basic mechanism of hepatic ischemia – reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5'-triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models. The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well.

Evidence Acquisition

The purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years.

Context

Ischemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery.

Conclusions

The management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.

Results

The basic mechanism of hepatic ischemia – reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5'-triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models. The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well.

Evidence Acquisition

The purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years.

Context

Ischemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery.

Conclusions

The management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.

Reperfusion Injury;Ischemia;Pathophysiology;Prevention Reperfusion Injury;Ischemia;Pathophysiology;Prevention 63 70 http://www.archtrauma.com/index.php?page=article&article_id=12501 Dimitrios Papadopoulos Dimitrios Papadopoulos 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece Thomas Siempis Thomas Siempis 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. Tel: +30-6978659716 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece. Tel: +30-6978659716 Eleni Theodorakou Eleni Theodorakou 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece Georgios Tsoulfas Georgios Tsoulfas 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
en 10.5812/atr.11300 Clinical Outcomes of the Ilizarov Method After an Infected Tibial Non Union Clinical Outcomes of the Ilizarov Method After an Infected Tibial Non Union research-article research-article Conclusions

Our results in terms of ASAMI scores are comparable with the published literature. Furthermore, our return to work is better than most European studies (63%). All our patients said they would have the procedure again. We attribute this success partly to the multidisciplinary approach. We recommend early referral to a dedicated unit if there is any evidence of a non-union.

Results

All twelve patients united. None required amputation. Mean time to union was 46 weeks (range 24 - 70/median 50). The average follow up time was 62 weeks (39 - 164/ median 59). According to the ASAMI score bone/radiological results ten were classed as excellent with the remainder being good. Functionally six were graded as excellent, four as good and two as poor. The average AOFAS score was 83/100 (70 - 90) and pain visual analogue scale (VAS) was two.

Objectives

To assess whether a new limb reconstruction centre in the UK has comparable results.

Patients and Methods

Twelve patients (10 M: 2 F; Avg age 43.3 years) who had an infected tibial non-union between March 2009 and August 2010 treated with the Ilizarov technique. Intervention method was Ilizarov technique and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analogue Pain scores.

Background

The Ilizarov technique has been used in the UK for the last 20 years in the management of infected non-union of long bones. This method uses fine wires inserted percutaneously which are attached and tensioned to provide a strong frame construct. The majority of tibial and femoral non unions can be treated successfully by internal fixation. However, an infected non-union of the tibia can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries.

Conclusions

Our results in terms of ASAMI scores are comparable with the published literature. Furthermore, our return to work is better than most European studies (63%). All our patients said they would have the procedure again. We attribute this success partly to the multidisciplinary approach. We recommend early referral to a dedicated unit if there is any evidence of a non-union.

Results

All twelve patients united. None required amputation. Mean time to union was 46 weeks (range 24 - 70/median 50). The average follow up time was 62 weeks (39 - 164/ median 59). According to the ASAMI score bone/radiological results ten were classed as excellent with the remainder being good. Functionally six were graded as excellent, four as good and two as poor. The average AOFAS score was 83/100 (70 - 90) and pain visual analogue scale (VAS) was two.

Objectives

To assess whether a new limb reconstruction centre in the UK has comparable results.

Patients and Methods

Twelve patients (10 M: 2 F; Avg age 43.3 years) who had an infected tibial non-union between March 2009 and August 2010 treated with the Ilizarov technique. Intervention method was Ilizarov technique and main outcome measures include functional and radiological outcomes assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria, American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analogue Pain scores.

Background

The Ilizarov technique has been used in the UK for the last 20 years in the management of infected non-union of long bones. This method uses fine wires inserted percutaneously which are attached and tensioned to provide a strong frame construct. The majority of tibial and femoral non unions can be treated successfully by internal fixation. However, an infected non-union of the tibia can prove a difficult problem. The Ilizarov method can prove useful for treating these complex injuries.

Ilizarov; Tibial Non Union; Osteomyelitis Ilizarov; Tibial Non Union; Osteomyelitis 71 75 http://www.archtrauma.com/index.php?page=article&article_id=11300 Mohammad Shahid Mohammad Shahid Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK; 65 Frederick Road, Selly Oak, Birmingham B29 6NX, UK. Tel/Fax: +44-7540304272 Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK; 65 Frederick Road, Selly Oak, Birmingham B29 6NX, UK. Tel/Fax: +44-7540304272 Abid Hussain Abid Hussain Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK Phillipa Bridgeman Phillipa Bridgeman Queen Elizabeth Hospital, Birmingham, UK Queen Elizabeth Hospital, Birmingham, UK Deepa Bose Deepa Bose Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK Limb Reconstruction Unit, Queen Elizabeth Hospital, Birmingham, UK
en 10.5812/atr.8549 S100B Protein as a Post-traumatic Biomarker for Prediction of Brain Death in Association With Patient Outcomes S100B Protein as a Post-traumatic Biomarker for Prediction of Brain Death in Association With Patient Outcomes research-article research-article Conclusions

Changes in S100B protein, especially the levels of this dimer 48 hours after trauma can be used as marker to predict brain death. Alongside other known prognostic factors such as age, GCS and diameters of the pupils, however, this factor individually can not conclusive predict the patient's clinical course and incidence of brain death. However, it is suitable to use GCS, CT scan, clinical symptoms and biomarkers together for a perfect prediction of brain death.

Results

Primary and the last GCS of patients had a predictive value in determining brain death (P < 0.0005), also there was a significant correlation between GCS and level of S100B protein. There was a significant correlation between CT scan findings and S100B protein only after 48 hours of trauma.

Background

S100B is a calcium-binding protein, belonging to the S100 family proteins which are characterized by their high solubility and, currently, comprises 21 members which are expressed in a cell-specific manner. If we can predict the possibility of definite brain death after brain injury, we will rescue some organs of body to transplant proposes.

Patients and Methods

72 patients (50 male and 22 female) aged 5 - 80 years old (median 40 ± 17.72 years) with severe head traumas (GCS ≤ 8) were recruited in this cross-sectional study. Glasgow Coma Scale (GCS) and computed tomography (CT) scan findings were recorded for all patients, and then a single 5mL blood sample was obtained from each patient on admission, after 48 hours and a week later or after brain death to determine the level of S100B protein.

Objectives

In this regard our study focused on the S100B protein value in predicting brain death after head trauma. In this study, the use of serum level of protein S100, 24 hours after trauma has been considered as a reliable index for predicting brain death.

Conclusions

Changes in S100B protein, especially the levels of this dimer 48 hours after trauma can be used as marker to predict brain death. Alongside other known prognostic factors such as age, GCS and diameters of the pupils, however, this factor individually can not conclusive predict the patient's clinical course and incidence of brain death. However, it is suitable to use GCS, CT scan, clinical symptoms and biomarkers together for a perfect prediction of brain death.

Results

Primary and the last GCS of patients had a predictive value in determining brain death (P < 0.0005), also there was a significant correlation between GCS and level of S100B protein. There was a significant correlation between CT scan findings and S100B protein only after 48 hours of trauma.

Background

S100B is a calcium-binding protein, belonging to the S100 family proteins which are characterized by their high solubility and, currently, comprises 21 members which are expressed in a cell-specific manner. If we can predict the possibility of definite brain death after brain injury, we will rescue some organs of body to transplant proposes.

Patients and Methods

72 patients (50 male and 22 female) aged 5 - 80 years old (median 40 ± 17.72 years) with severe head traumas (GCS ≤ 8) were recruited in this cross-sectional study. Glasgow Coma Scale (GCS) and computed tomography (CT) scan findings were recorded for all patients, and then a single 5mL blood sample was obtained from each patient on admission, after 48 hours and a week later or after brain death to determine the level of S100B protein.

Objectives

In this regard our study focused on the S100B protein value in predicting brain death after head trauma. In this study, the use of serum level of protein S100, 24 hours after trauma has been considered as a reliable index for predicting brain death.

Posttraumatic Brain Death;Predictor;Biomarkers;S100B Protein;Outcome Posttraumatic Brain Death;Predictor;Biomarkers;S100B Protein;Outcome 76 80 http://www.archtrauma.com/index.php?page=article&article_id=8549 Moslem Shakeri Moslem Shakeri Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran; Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4113340830, Fax: +98-4113340830 Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran; Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4113340830, Fax: +98-4113340830 Atta Mahdkhah Atta Mahdkhah Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran Department of Neurosurgery, Tabriz University of Medical Sciences, Tabriz, IR Iran Farid Panahi Farid Panahi Neurosciences Reserch Center, Tabriz University of Medical Sciences, Tabriz, IR Iran Neurosciences Reserch Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
en 10.5812/atr.12088 Iatrogenic Gastrointestinal Injuries During Obstetrical and Gynecological Operation Iatrogenic Gastrointestinal Injuries During Obstetrical and Gynecological Operation research-article research-article Conclusions

All of the gynecologic surgeons must be aware of gastrointestinal injuries and should anticipate injury to these organs especially in high-risk patients for decreasing patient morbidity.

Results

The mean age of women was 33.2 ± 7.57 years. 44% of the patients had a history of abdominal scar. 32% of all GI injuries occurred during total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases. 52% of injuries were diagnosed during the operation and the mean time of injury diagnosis was 2.8 ± 0.9 days.

Background

Gastrointestinal Injuries (GI) during gynecological operation are uncommon but proper management of these injuries is very important.

Objectives

The aim of this study was to review the causes and management of gastrointestinal injuries during gynecological and obstetrical operations.

Patients and Methods

In this descriptive retrospective study, 25 patients with gastrointestinal injuries during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery or procedure, history of laparotomy, the surgical operation, injury site, time of diagnosis and method of treatment were extracted from medical records.

Conclusions

All of the gynecologic surgeons must be aware of gastrointestinal injuries and should anticipate injury to these organs especially in high-risk patients for decreasing patient morbidity.

Results

The mean age of women was 33.2 ± 7.57 years. 44% of the patients had a history of abdominal scar. 32% of all GI injuries occurred during total abdominal hysterectomy (TAH). The small bowel was injured in 36% of cases. 52% of injuries were diagnosed during the operation and the mean time of injury diagnosis was 2.8 ± 0.9 days.

Background

Gastrointestinal Injuries (GI) during gynecological operation are uncommon but proper management of these injuries is very important.

Objectives

The aim of this study was to review the causes and management of gastrointestinal injuries during gynecological and obstetrical operations.

Patients and Methods

In this descriptive retrospective study, 25 patients with gastrointestinal injuries during gynecological and obstetrical operation at Shabihkhani Maternity Hospital in Kashan city were reviewed. Demographic data such as age, gravid, parity, type of surgery or procedure, history of laparotomy, the surgical operation, injury site, time of diagnosis and method of treatment were extracted from medical records.

Injuries;Gynecology;Surgery Injuries;Gynecology;Surgery 81 84 http://www.archtrauma.com/index.php?page=article&article_id=12088 Elaheh Mesdaghinia Elaheh Mesdaghinia Department of Obstetrics and Gynecology, Kashan University of Medical Sciences, Kashan, IR Iran Department of Obstetrics and Gynecology, Kashan University of Medical Sciences, Kashan, IR Iran Masoumeh Abedzadeh-Kalahroudi Masoumeh Abedzadeh-Kalahroudi Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615620634 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615620634 Mehrdad Hedayati Mehrdad Hedayati Deputy of Health, Kashan University of Medical Sciences, Kashan, IR Iran Deputy of Health, Kashan University of Medical Sciences, Kashan, IR Iran Nushin Moussavi-Bioki Nushin Moussavi-Bioki Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran Department of General Surgery, Kashan University of Medical Sciences, Kashan, IR Iran
en 10.5812/atr.9127 Quality of Care for Patients With Traction in Shahid Beheshti Hospital in 2012 Quality of Care for Patients With Traction in Shahid Beheshti Hospital in 2012 research-article research-article Background

With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation.

Objectives

This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran.

Patients and Methods

An observational study was conducted on patients with traumatic fractures of hip and femur bones who were admitted to Kashan's Shahid Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data was collected using a checklist including questions about personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and independent sample t test and Pearson correlation coefficient was used to analyze the data.

Results

A total of 100 patients were examined, among them 66% were male. The mean age of patients was 51.16 ± 23.28 years. In total, 47% of the patients were treated via Skin traction and 53% by skeletal traction. Overall, mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02).

Conclusions

The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area.

Background

With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation.

Objectives

This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran.

Patients and Methods

An observational study was conducted on patients with traumatic fractures of hip and femur bones who were admitted to Kashan's Shahid Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data was collected using a checklist including questions about personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and independent sample t test and Pearson correlation coefficient was used to analyze the data.

Results

A total of 100 patients were examined, among them 66% were male. The mean age of patients was 51.16 ± 23.28 years. In total, 47% of the patients were treated via Skin traction and 53% by skeletal traction. Overall, mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02).

Conclusions

The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area.

Quality of Health Care;Patients;Skeletal Traction;Skin Traction Quality of Health Care;Patients;Skeletal Traction;Skin Traction 85 90 http://www.archtrauma.com/index.php?page=article&article_id=9127 Mohsen Adib Hajbaghery Mohsen Adib Hajbaghery Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Nursing Research Center, Kashan University of Medical Sciences. Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615556633 Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran; Trauma Nursing Research Center, Kashan University of Medical Sciences. Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615556633 Tayebeh Moradi Tayebeh Moradi Student Research Committee, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran Student Research Committee, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
en 10.5812/atr.9877 Prevalence of Hyponatremia in Intensive Care Unit Patients With Brain Injury in Shahid Beheshti Hospital of Kashan During 2012 Prevalence of Hyponatremia in Intensive Care Unit Patients With Brain Injury in Shahid Beheshti Hospital of Kashan During 2012 research-article research-article Background

Hyponatremia is a common disorder in patients with brain injury. It can result in acute and chronic complications providing this electrolytic disorder is not diagnosed and treated in due time.

Objectives

The aim of this study was to evaluate the prevalence of hyponatremia in 95 patients with brain injury hospitalized in the intensive care unit in Shahid Beheshti hospital of Kashan University of Medical Sciences.

Conclusions

Our study showed an elevated frequency of hyponatremia in patients with brain injuries in the intensive care unit which demands effective approaches for accurate and timely diagnosis of this electrolyte disorder.

Results

Among the 95 patients with brain injury, mean age was 42.85 ± 22.59 years, while the hyponatremic patients had a mean age of 48.37 ± 24.03 years of which 69.5% were male and 30.5% were female. Prevalence and occurrence of hyponatremia were 31.6% and 9.29 ± 6.8 days, respectively. This study revealed no meaningful differences between age, sex, underlying disease and prevalence of hyponatremia.

Patients and Methods

This trans-sectional study was conducted on brain injury patients (brain traumas, brain hemorrhage, meningitis and brain tumors) during their six-month stay in the Intensive Care Unit (ICU) in Shahid Beheshti hospital. The data was then analyzed after excluding cases of pseudohyponatremia.

Background

Hyponatremia is a common disorder in patients with brain injury. It can result in acute and chronic complications providing this electrolytic disorder is not diagnosed and treated in due time.

Objectives

The aim of this study was to evaluate the prevalence of hyponatremia in 95 patients with brain injury hospitalized in the intensive care unit in Shahid Beheshti hospital of Kashan University of Medical Sciences.

Conclusions

Our study showed an elevated frequency of hyponatremia in patients with brain injuries in the intensive care unit which demands effective approaches for accurate and timely diagnosis of this electrolyte disorder.

Results

Among the 95 patients with brain injury, mean age was 42.85 ± 22.59 years, while the hyponatremic patients had a mean age of 48.37 ± 24.03 years of which 69.5% were male and 30.5% were female. Prevalence and occurrence of hyponatremia were 31.6% and 9.29 ± 6.8 days, respectively. This study revealed no meaningful differences between age, sex, underlying disease and prevalence of hyponatremia.

Patients and Methods

This trans-sectional study was conducted on brain injury patients (brain traumas, brain hemorrhage, meningitis and brain tumors) during their six-month stay in the Intensive Care Unit (ICU) in Shahid Beheshti hospital. The data was then analyzed after excluding cases of pseudohyponatremia.

Hyponatremia;Brain Injury;Intensive Care Unit Hyponatremia;Brain Injury;Intensive Care Unit 91 94 http://www.archtrauma.com/index.php?page=article&article_id=9877 Zahra Chitsazian Zahra Chitsazian Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Batool Zamani Batool Zamani Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3614440838, Fax: +98-3615558900 Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3614440838, Fax: +98-3615558900 Maryam Mohagheghfar Maryam Mohagheghfar Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
en 10.5812/atr.10866 Gastric Intramural and Portal Venous Gas Following Blunt Abdominal Injury Gastric Intramural and Portal Venous Gas Following Blunt Abdominal Injury case-report case-report Introduction

Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post trauma patients.

Case Presentation

A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well.

Conclusions

Early surgical management is indicated in patients post trauma in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma - conservative management with close clinical observation is a suitable management alternative.

Introduction

Gastric emphysema or pneumatosis is a rare finding. Early endoscopy and urgent laparotomy is advised in post trauma patients.

Case Presentation

A 29 year old man presented with blunt abdominal injury following a high-speed motorbike crash He complained of abdominal pain and abdomen was distended. CT abdomen revealed air in the gastric wall with disruption of gastric mucosa. He had normal white cell counts, bleeding parameters and blood gases. He was treated conservatively with nasogastric decompression, intravenous analgesics and antibiotics with which he recovered well.

Conclusions

Early surgical management is indicated in patients post trauma in whom bowel infarction is suspected. In a stable patient, a negative laparotomy is a major additional stress post trauma - conservative management with close clinical observation is a suitable management alternative.

Air;Gastric;Blunt Trauma Air;Gastric;Blunt Trauma 95 96 http://www.archtrauma.com/index.php?page=article&article_id=10866 Indrani Sen Indrani Sen Department of Surgery, Christian Medical College, Vellore, India; Department of Surgery, Christian Medical College, Vellore 632004, India. Tel.: +91-4162282085, Fax: +91-4162232035 Department of Surgery, Christian Medical College, Vellore, India; Department of Surgery, Christian Medical College, Vellore 632004, India. Tel.: +91-4162282085, Fax: +91-4162232035 Inian Samarasam Inian Samarasam Department of Surgery, Christian Medical College, Vellore, India Department of Surgery, Christian Medical College, Vellore, India Sudhakar Chandran Sudhakar Chandran Department of Surgery, Christian Medical College, Vellore, India Department of Surgery, Christian Medical College, Vellore, India George Mathew George Mathew Department of Surgery, Christian Medical College, Vellore, India Department of Surgery, Christian Medical College, Vellore, India
en 10.5812/atr.11011 Gabapentin and Diclofenac Reduce Opioid Consumption in Patients Undergoing Tonsillectomy: A Result of Altered CNS Drug Delivery? Gabapentin and Diclofenac Reduce Opioid Consumption in Patients Undergoing Tonsillectomy: A Result of Altered CNS Drug Delivery? letter letter Blood-Brain Barrier;CNS Drug Delivery;Opioid Analgesic;Transporters Blood-Brain Barrier;CNS Drug Delivery;Opioid Analgesic;Transporters 97 98 http://www.archtrauma.com/index.php?page=article&article_id=11011 Patrick T. Ronaldson Patrick T. Ronaldson Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, USA; Department of Medical Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA , +1-5206262173 Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, USA; Department of Medical Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, USA , +1-5206262173 Thomas P. Davis Thomas P. Davis Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, USA Department of Medical Pharmacology, University of Arizona College of Medicine, Tucson, USA
en 10.5812/atr.10117 Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy letter letter Pain;Gabapentin;Diclofenac;Tonsillectomy Pain;Gabapentin;Diclofenac;Tonsillectomy 99 100 http://www.archtrauma.com/index.php?page=article&article_id=10117 Visnja Nesek Adam Visnja Nesek Adam University Department of Anesthesiology, Resuscitation and Intensive Care, University of Osijek, Osijek, Croatia; University Department of Anesthesiology, Resuscitation and Intensive Care, University of Osijek, Osijek, Croatia. Tel: +38-5913712136, Fax: +385013712111 University Department of Anesthesiology, Resuscitation and Intensive Care, University of Osijek, Osijek, Croatia; University Department of Anesthesiology, Resuscitation and Intensive Care, University of Osijek, Osijek, Croatia. Tel: +38-5913712136, Fax: +385013712111