Assault rifle injuries in civilians: ballistics of wound patterns, assessment and initial management.

Purpose: Wounds from assault rifles and their commercial offspring have been encountered with increasing frequency in civilian practice. Our aim is to summarize wound ballistics related to the main injury patterns that can also affect management strategies.

Methods: An online search of the PubMed was conducted for research and review articles published after 2000 in English, using the MeSH terms "gunshot wounds", "mass casualty incidents", "war-related injuries", "soft tissue injuries", "vascular system injuries", "colon injuries", "wound infection", "antibiotic prophylaxis", "debridement", "hemorrhage", "penetrating head injuries", "pneumothorax" and additional free-text terms.

Use of Therapeutic Apheresis methods in ICU.

Apheresis is a modern medical approach in which plasma or cellular components are separated from the whole blood. Apheresis can be either diagnostic or therapeutic. Diagnostic apheresis is typically applied in hematology and cancer research.

Apheresis and COVID-19 in intensive care unit (ICU).

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first known case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, and on March 2020 the World Health Organization (WHO) declared it as pandemic, causing a public health crisis.

Publisher Correction: Exposure to Stress-Dose Steroids and Lethal Septic Shock After In-Hospital Cardiac Arrest: Individual Patient Data Reanalysis of Two Prior Randomized Clinical Trials that Evaluated the Vasopressin-Steroids-Epinephrine Combination Versus Epinephrine Alone.

The original version of this article unfortunately contained a mistake. In Table 2, the frequency of Septic Shock reported just below the frequency of "At least 1 Episode of VAP" actually corresponds to the First (and not the Second) Episode of VAP during the postresuscitation period.

Exposure to Stress-Dose Steroids and Lethal Septic Shock After In-Hospital Cardiac Arrest: Individual Patient Data Reanalysis of Two Prior Randomized Clinical Trials that Evaluated the Vasopressin-Steroids-Epinephrine Combination Versus Epinephrine Alone.

Purpose: Low-dose steroids may reduce the mortality of severely ill patients with septic shock. We sought to determine whether exposure to stress-dose steroids during and/or after cardiopulmonary resuscitation is associated with reduced risk of death due to postresuscitation septic shock.

Methods: We analyzed pooled, individual patient data from two prior, randomized clinical trials (RCTs).

Neuroprotective Effects of Erythropoietin in Patients with Severe Closed Brain Injury.

Aim: Our research was focused on the neuroprotective function of erythropoietin (Epo) in patients with severe closed traumatic brain injury (TBI).

Material And Methods: Our model examined the influence of the outcome and neurological recovery in 42 adults with TBI who were admitted to ICU within 6 hours of their injury and were recruited into a randomized controlled study of two groups; only the patients of the intervention group received 10,000 i.u.

Fatal cardiac tamponade as the first manifestation of acute myeloid leukemia.

Acute myeloid leukemia is a hemopoietic myeloid stem cell neoplasm. It is the most common acute leukemia affecting adults,and its incidence increases with age. Acute myeloid leukemia is characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells.

The immune response after stimulation with wall components of gram-positive bacteria and fungi.

Although several components of the microbial wall of gram-positive bacteria and fungi possess immunostimulatory properties, their pathogenetic role remains incompletely evaluated. The purpose of this study was to assess the basic immune status of patients susceptible to infections and their capability for cytokine production after stimulation with wall components of gram-positive bacteria and fungi. We measured serum cytokine levels as well as cytokine production after ex vivo lipoteichoic acid (LTA) and mannan stimulation of whole blood.

Permissive hypotension in bleeding trauma patients: helpful or not and when?

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions.

Vasopressin, steroids, and epinephrine and neurologically favorable survival after in-hospital cardiac arrest: a randomized clinical trial.

Importance: Among patients with cardiac arrest, preliminary data have shown improved return of spontaneous circulation and survival to hospital discharge with the vasopressin-steroids-epinephrine (VSE) combination.

Objective: To determine whether combined vasopressin-epinephrine during cardiopulmonary resuscitation (CPR) and corticosteroid supplementation during and after CPR improve survival to hospital discharge with a Cerebral Performance Category (CPC) score of 1 or 2 in vasopressor-requiring, in-hospital cardiac arrest.

Design, Setting, And Participants: Randomized, double-blind, placebo-controlled, parallel-group trial performed from September 1, 2008, to October 1, 2010, in 3 Greek tertiary care centers (2400 beds) with 268 consecutive patients with cardiac arrest requiring epinephrine according to resuscitation guidelines (from 364 patients assessed for eligibility).

Less common nontraumatic bowel perforations: diagnosis and management through a retrospective study.

Nontraumatic bowel perforation has always been a consideration because of associated morbidity and mortality. The aim of this study is to define etiologies, treatment, and outcomes as well as to highlight difficulties in the diagnosis and management of nontraumatic bowel perforation. We conducted a retrospective study of 35 patients with less common nontraumatic bowel perforations hospitalized during a six-year period.

Lung Abscess in a Patient With VAP: A Rare Case of Lung Infection Complicated by Two Pathogens.

Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient after intubation with an endotracheal tube or tracheostomy tube lasting for 48 hours or more. We describe a case of 75-year-old male who initially presented with pneumonia of the right basis with accompanying plevritis. The patient was intubated and his condition was complicated with a VAP infection while he developed a lung abscess.

H1N1 Influenza Viral Infection in a Postpartum Young Woman Causes Respiratory Failure: What the Care Providers Ought to Know?

Pregnant and postpartum women are considered a population at increased risk of hospitalization of H1N1 infection. We report the case of a young postpartum woman, who developed evidence of respiratory failure reaching the point of requiring intubation due to an H1N1 influenza virus infection two days after a caesarean delivery. We emphasize the diagnosis, management, and the outcome focusing on the question "what the care providers, including obstetric health care workers, ought to know?" Diagnostic and management strategy for pregnant or postpartum women with novel influenza A (H1N1) viral infection and increased awareness amongst patients and health care professionals may result in improved survival.

Spontaneous Rupture of Splenic Artery Aneurysm during the First Trimester of Pregnancy: Report of an Extremely Rare Case and Review of the Literature.

Splenic artery aneurysm (SAA) occurs predominantly in women and the majority of them are asymptomatic until rupture. In cases of spontaneous rupture of an SAA, maternal and fetal mortality rates remain extremely high. Furthermore, the spontaneous ruptures of SAAs predominantly appear during the third trimester of pregnancy.

Takotsubo cardiomyopathy: a hidden enemy of the hypovolemic patient?

Takotsubo cardiomyopathy (TCM) is an underrecognized transient left ventricular dysfunction that mimics clinically an acute coronary syndrome. It has been linked to emotional stress and several clinical entities that provoke a catecholamine surge in the blood stream. We investigated the case of a young female patient who was admitted to the intensive care unit after a significant blood loss due to miscarriage.

Platypnea-orthodeoxia due to fat embolism.

Platypnea-orthodeoxia is an uncommon syndrome that is characterized by dyspnea relieved by recumbency and deoxygenation following a change from a recumbent to an upright posture. We herein describe a case of platypnea-orthodeoxia in a 75-year-old man after a surgical restoration of a bitrochanteric fracture of his right femur. However, in this extremely rare case, none of the current known anatomical or functional conditions which can cause platypnea-orthodeoxia had been diagnosed.

The effects of tobacco smoking on the incidence and risk of intraoperative and postoperative complications in adults.

Introduction: Despite the warnings of health hazards of cigarette smoking, still one third of the population in industrial countries smoke. This review was conducted with the aim of exploring the effects of preoperative tobacco smoking on the risk of intra- and postoperative complications and to identify the value of preoperative smoking cessation.

Methods: The databases that were searched included The Cochrane Library Database, Medline, and EMBASE.

Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report.

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large GIST of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of GIST.

Preoperative diagnosis of obscure gastrointestinal bleeding due to a GIST of the jejunum: a case report.

Gastrointestinal stromal tumours are rare mesenchymal neoplasms affecting the digestive tract or nearby structures within the abdomen. We present a case of a 66-year-old female patient who presented with obscure anemia due to gastrointestinal bleeding and underwent exploratory laparotomy during which a large gastrointestinal stromal tumour of the small intestine was discovered. Examining the preoperative results of video capsule endoscopy, computed tomography, and angiography and comparing them with the operative findings we discuss which of these investigations plays the most important role in the detection and localization of gastrointestinal stromal tumours.

Diagnosis and surgical management of spontaneous hepatic rupture associated with HELLP syndrome.

Spontaneous hepatic rupture with hemoperitoneum is an uncommon but devastating complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. Although the syndrome has been considered a variant of preeclampsia/eclampsia, its pathogenesis is not completely understood. Hepatic rupture increases the perinatal and maternal morbidity and mortality.

Large mass affecting retroperitoneal great vessels: a rare presentation of a cancer of unknown primary with diagnostic dilemma and challenged surgical intervention.

Introduction: Cancers of unknown primary site (CUPs) consist of a clinical entity which accounts for 3-5% of all solid tumor patients. They are metastatic solid tumors whose fundamental characteristic is the absence of identifiable site of the primary tumor.

Case Report: We report the case of a completely asymptomatic 34-year-old man with a palpated huge mass found incidentally in the left abdomen.

Successful use of recombinant activated factor VII for postoperative associated haemorrhage: a case report.

Background: Coagulopathy is a major contributing factor to bleeding related mortality even after achieving adequate surgical control of the haemorrhage in trauma and surgical patients.

Case Presentation: A 65 years old Greek man was admitted in our ICU with critical haemorrhage following renal biopsy. Despite surgical exploration the patient continued to bleed resulting in a vicious cycle of transfusion, coagulopathy and re-bleeding.

Recurrent Jarisch-Herxheimer reaction in a patient with Q fever pneumonia: a case report.

Q fever is a zoonotic disease caused by coxiella burnetii. The Jarisch-Herxheimer reaction (JHR) is associated with the antibiotic treatment of certain bacterial infections. We report a very rare case of a 36-year-old male with Q fever pneumonia that resulted in recurrent ARDS and presented the JHR during his treatment.