Clinical presentation, acute care management and discharge information of patients with thoracic trauma in South Africa and Sweden: a prospective multicenter observational study.

Purpose: Thoracic trauma causes pain and hospitalisation. Middle- and high-income countries have different trauma contexts and populations. To report patients' clinical presentation (pain and shortness of breath) and its influence on hospital length of stay (LOS), acute care management, and discharge destinations in South Africa (SA) and Sweden.

ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings.

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking.

PragmaTic, prospEctive, randomized, controlled, double-blind, mulTi-centre, multinational study on the safety and efficacy of a 6% HydroxYethyl Starch (HES) solution versus an electrolyte solution in trauma patients: study protocol for the TETHYS study.

Background: Trauma may be associated with significant to life-threatening blood loss, which in turn may increase the risk of complications and death, particularly in the absence of adequate treatment. Hydroxyethyl starch (HES) solutions are used for volume therapy to treat hypovolemia due to acute blood loss to maintain or re-establish hemodynamic stability with the ultimate goal to avoid organ hypoperfusion and cardiovascular collapse. The current study compares a 6% HES 130 solution (Volulyte 6%) versus an electrolyte solution (Ionolyte) for volume replacement therapy in adult patients with traumatic injuries, as requested by the European Medicines Agency to gain more insights into the safety and efficacy of HES in the setting of trauma care.

Posttraumatic Natural Killer Cell Decrease is Associated with Septic Complications.

Background: There has been paucity in prospective studies investigating trauma-induced changes in the cellular immunity of HIV-seropositive patients and their impact on the clinical outcome after trauma surgery. The role of natural killer (NK) cells especially has not yet been fully elucidated, and the function of this lymphocyte subtype in the immune defense after trauma is still under debate.

Methods: This prospective study included patients requiring surgery for abdominal gunshot wounds.

Compromised Gut Associated Lymphoid Tissue is a Risk Factor for Postoperative Septic Complications in HIV-Seropositive Trauma Patients.

Background: The gut associated lymphoid tissue (GALT) is an important part of the immune system and compromised in HIV treatment-naïve as well as in HIV-seropositive patients on antiretroviral treatment (ART) due to HIV-induced changes. The influence of the impaired GALT on the postoperative complication rate after surgery for penetrating abdominal trauma has not been investigated and the hypothesis that the HIV-induced changes of the GALT contribute to septic complications postoperatively was tested.

Material And Methods: This prospective study included patients who required a small bowel resection due to abdominal gunshot wounds.

Trauma results in immune cell-induced intestinal epithelial damage with subsequently increased sepsis rate.

Background: The detrimental effect of trauma on the immune system has been a subject of interest for decades. The gut-associated lymphoid tissue (GALT) of the bowel that encompasses different lymphocyte subpopulations may be an important pillar of human immunity in the context of trauma. Neither the short-term histological trauma-induced changes in the GALT nor its impact on the outcome after trauma surgery has been investigated.

Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma.

Introduction: The influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks.

Methods: This was a prospective study including 98 patients with small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma.

On a knife-edge: clinical uncertainty with an extensive knife blade in situ in the craniofacial region.

A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient.

The challenges of developing a trauma system for Indigenous people.

Trauma systems have been shown to provide the best trauma care for injured patients. A trauma system developed for Indigenous people should take into account many factors including geographical remoteness and cultural diversity. Indigenous people suffer from a significant intentional and non-intentional burden of injury, often greater than non-Indigenous populations, and a public health approach in dealing with trauma can be adopted.

The use of low dosage X-ray (Lodox/Statscan) in major trauma: comparison between low dose X-ray and conventional x-ray techniques.

Background: Patients presenting with major trauma normally require resuscitation, usually carried out according to techniques laid down by the Advanced Trauma Life Support (ATLS) Program of the American College of Surgeons. Techniques normally suggested include the routine radiology of the cervical spine, chest and pelvis. This can sometimes be time consuming and may not return helpful information in all cases.

Death and injury on duty--a study of South African police officers.

Objectives: Sections of contemporary South African society are characterised by high levels of crime and interpersonal conflict. The South African Police Service (SAPS) is in the front line, with many deaths and injuries occuring among serving officers in recent years. The circumstances and nature of the injuries sustained by these officers have received little attention in the medical literature.

Intubated, ventilating patients with complete tracheal transection: a diagnostic challenge.

Tracheal transection is a rare injury after blunt trauma. The presence of complete tracheal transection in the intubated, ventilating patient is even more rare and constitutes a major diagnostic challenge. The liberal use of computed tomography (CT) scans as an adjunct to endoscopy is paramount.