Browsing by Subject "Trauma"

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  • Suomalainen, L.; Haravuori, H.; Berg, N.; Kiviruusu, O.; Marttunen, M. (2011)
    Background: In November 2007, a student shot eight people and himself at Jokela High School, Finland. This study aims to evaluate the long-term effects of exposure to a school shooting among adolescents. Method: Associations between psychological outcomes and background factors were analysed and compared with "comparison students" four months after the incident. A questionnaire including Impact of Event Scale (IES) and General Health Questionnaire (GHQ-36) was used. Results: Half of the females and a third of the males suffered from posttraumatic distress. High level of posttraumatic distress (IES >= 35), predicting PTSD, was observed in 27% of the females and 7% of the males. The odds ratio was 6.4 (95% confidence interval 3.5-10.5) for having high levels of posttraumatic distress. Severe or extreme exposure and female gender were found to increase the risk. Forty-two percent of the females and 16% of the males had psychiatric disturbance (GHQ >= 9). Severe or extreme exposure, older age and female gender increased the risk. Perceived support from family and friends was found to be protective. Conclusions: The observed risk and protective factors were similar to earlier studies. Follow-up will be essential in identifying factors predicting persisting trauma-related symptoms in adolescence. (C) 2010 Elsevier Masson SAS. All rights reserved.
  • Kangaslampi, Samuli; Garoff, Ferdinand; Golden, Shannon; Peltonen, Kirsi (2021)
    We analyzed the network structure of DSM-IV PTSD symptoms among 2792 help-seeking Central and East African refugees in Kenya exposed to multiple, severe traumatic events and on-going stressors. To some extent, our results reproduced structures identified among clinical populations in Europe, including strong links within traditional symptom clusters, such as between avoidance of thoughts and situations, and hypervigilance and startling. However, we found substantial differences in most central symptoms, with detachment and disinterest far less and emotional numbing and concentration problems more central in our analyses. Our networks did not reproduce the common finding of particularly low centrality of amnesia. We further noted substantive similarities in network structure, but also differences, between refugees living in an urban environment and in refugee camps. Concentration problems were most central among mainly Somali refugees at a refugee camp, and associated with amnesia and sense of foreshortened future, while emotional numbing was the most central symptom among majority Congolese refugees in Nairobi. Our findings highlight the importance of contextual and cultural factors for PTSD symptomatology, and are informative for assessment and treatment among help-seeking refugees.
  • Bensch, Frank; Varjonen, Elina A.; Pyhältö, Tuomo T.; Koskinen, Seppo K. (2019)
    Purpose BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. Methods Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. Results 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p <.0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. Conclusions The increase in detection rate for BCVI justifies more liberal screening protocols.
  • Irfan, Furqan B.; Consunji, Rafael; El-Menyar, Ayman; George, Pooja; Peralta, Ruben; Al-Thani, Hassan; Thomas, Stephen Hodges; Alinier, Guillaume; Shuaib, Ashfaq; Al-Suwaidi, Jassim; Singh, Rajvir; Castren, Maaret; Cameron, Peter A.; Djarv, Therese (2017)
    Background: Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. Methods: An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA). Results: A total of 410 OHTCA patients were included in the 6-year study period. The mean annual crude incidence rate of OHTCA was 4.0 per 100,000 population, in Qatar. OHTCA mostly occurred in males with a median age of 33. There was a preponderance of blunt injuries (94.3%) and head injuries (66.3%). Overall, the survival rate was 2.4%. Shockable rhythm, prehospital external hemorrhage control, in-hospital blood transfusion, and surgery were associated with higher odds of survival. Adrenaline (Epinephrine) lowered the odds of survival. Conclusion: The incidence of OHTCA was less than expected, with a low rate of survival. Thoracotomy was not associated with improved survival while Adrenaline administration lowered survival in OHTCA patients with majority blunt injuries. Interventions to enable early prehospital control of hemorrhage, blood transfusion, thoracostomy and surgery improved survival. (C) 2017 Elsevier B.V. All rights reserved.
  • Erkman, Ahmet Cem; Basoglu, Oksan; Basibuyuk, Gulusan Ozgun; Kirmizioglu, Pinar Gozluk; Yigit, Ayhan; Yalcin, Yarenkur Alkan; Kaya, Ferhat (2016)
    The excavations conducted at Van Castle Mound, East Anatolia, between 1987 and 2010 uncovered a total of 328 human skeletons dating back to the Medieval period. Thirty trauma cases were identified within the collection, constituting 9.14% of the entire population. Typology and distribution of the trauma among different sexes indicated that depression fractures, oblique fractures, comminuted fractures, and head deformation were more frequently observed in male skeletons, while a post-fractural infection appeared only in a female skeleton. Trauma cases were more common on post-cranial bones. In addition, a trepanned cranial specimen belonging to a mature individual is identified in which grooving technique was performed. Most of the observed trauma cases were related to heavy labor, unsafe working conditions, and challenges of everyday agrarian life. Previous paleopathological studies from the Medieval Van Castle Mound also indicates an insufficient nutritation and high physical stress.
  • Wahlin, Rebecka Rubenson; Ponzer, Sari; Skrifvars, Markus B.; Lossius, Hans Morten; Castren, Maaret (2016)
    Background: Trauma systems and regionalized trauma care have been shown to improve outcome in severely injured trauma patients. The aim of this study was to evaluate the implementation of a prehospital trauma care protocol and transport directive, and to determine its effects on the number of primary admissions and secondary trauma transfers in a large Scandinavian city. Methods: We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County; patients > 15 years of age with an Injury Severity Score (ISS) > 15 transported to any emergency care hospitals in the Stockholm area were included for the years 2006 and 2008. We also included secondary transferred patients to the regional trauma center during 2006, 2008, and 2013. Results: A total of 693 primarily admitted trauma patients were included for the years 2006 and 2008. For the years 2006, 2008 and 2013, we included 114 secondarily transported trauma patients. The number of primary patient transports to the trauma center increased during the years by 20.2 %, (p <0.001); patients primarily transported to the trauma center had a significantly higher Injury Severity Score in 2008 than in 2006, and the number of patients transported secondarily to the trauma center in 2006 was higher compared to 2008 and to 2013 (p <0.001, all 3 years). Discussion: Our data indicate that implementation of a prehospital trauma care protocol may have an effect on transportation of severely injured trauma patients. A decrease in secondarily transported trauma patients to the regional trauma center was noted after 1 year and persisted at 7 years after the organizational change. Patients primarily admitted to the trauma center after the change had more severe injuries than patients transported to other emergency hospitals in the area even if 20 % of patients were not admitted primarily to a trauma center. This does not imply that the transport directives or the criteria were not followed but rather reveals the difficulties and uncertainties of field triage. Conclusions: With the introduction of a prehospital trauma transport directive in a large urban city, an increase in patients transported to the regional trauma center and a decrease in secondary transfers were detected, but a considerable number of severely injured patients were still transported to local hospitals.
  • Kangaspuro, Markku Veli; Lassila, Jussi Pekka (Palgrave Macmillan, 2017)
  • 2019 World Society of Emergency Surgery (WSES) Nijmegen splenic injury collaboration group; Amico, Francesco; Anning, Rebecca; Bendinelli, Cino; Balogh, Zsolt J.; Leppäniemi, Ari; Tolonen, Matti I A (2020)
    Background Recent trauma guidelines recommend non-operative management for grade III splenic injury without contrast extravasation on computed tomography. Nevertheless, such recommendations rely on low-quality evidence, and practice variation characterizes clinical management for this type of injury. We aimed to identify the role of eleven selected clinical factors influencing the management of grade III splenic injury without contrast extravasation by expert consensus and a modified Delphi approach. Methods A questionnaire was developed with the endorsement of the World Society of Emergency Surgery (WSES). This was delivered and answered live by acute care surgeons attending the 6(th)WSES congress in Nijmegen in 2019. A dedicated mobile phone application was utilized to collect the answers. All answers were evaluated for areas of discrepancy with an 80% threshold for consensus between respondents. Results Three factors generated discrepancy in opinion for managing this pattern of injury: the patients' injury severity, the presence of a bleeding diathesis, and an associated intra-abdominal injury. Agreement was obtained for the other eight factors. Conclusion Researchers should focus their efforts on the identified area of discrepancy. Clinicians should use additional care in the presence of the three factors for which discordant opinions were found.
  • Coccolini, Federico; Catena, Fausto; Montori, Giulia; Ceresoli, Marco; Manfredi, Roberto; Nita, Gabriela Elisa; Moore, Ernest E.; Biffl, Walter; Ivatury, Rao; Whelan, James; Fraga, Gustavo; Leppaniemi, Ari; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca (2015)
    Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to close the OA are still matter of debate. To overcome this lack of high level of evidence data about the OA indications, management, definitive closure and follow-up, the World Society of Emergency Surgery (WSES) promoted the International Register of Open Abdomen (IROA). The register will be held on a web platform (Clinical Registers (R)) through a dedicated web site: www. clinicalregisters. org. This will allow to all surgeons and physicians to participate from all around the world only by having a computer and a web connection. The IROA protocol has been approved by the coordinating center Ethical Committee (Papa Giovanni XXIII hospital, Bergamo, Italy).
  • Laaksonen, Sauli; Jokelainen, Pikka; Pusenius, Jyrki; Oksanen, Antti (BioMed Central, 2017)
    Abstract Background Slaughter reindeer are exposed to stress caused by gathering, handling, loading and unloading, and by conditions in vehicles during transport. These stress factors can lead to compromised welfare and trauma such as bruises or fractures, aspiration of rumen content, and abnormal odour in carcasses, and causing condemnations in meat inspection and lower meat quality. We investigated the statistical association of slaughter transport distance with these indices using meat inspection data from years 2004–2016, including inspection of 669,738 reindeer originating from Finnish reindeer herding areas. Results Increased stress and decreased welfare of reindeer, as indicated by higher incidence of carcass condemnation due to bruises or fractures, aspiration of rumen content, or abnormal odour, were positively associated with systems involving shorter transport distances to abattoirs. Significant differences in incidence of condemnations were also detected between abattoirs and reindeer herding cooperatives. Conclusions This study indicates that in particular the short-distance transports of reindeer merit more attention. While the results suggest that factors associated with long distance transport, such as driver education, truck design, veterinary supervision, and specialist equipment, may be favourable to reducing pre-slaughter stress in reindeer when compared with short distance transport systems, which occur in a variety of vehicle types and may be done by untrained handlers. Further work is required to elucidate the causal factors to the current results.
  • Laaksonen, Sauli; Jokelainen, Pikka; Pusenius, Jyrki; Oksanen, Antti (2017)
    Background: Slaughter reindeer are exposed to stress caused by gathering, handling, loading and unloading, and by conditions in vehicles during transport. These stress factors can lead to compromised welfare and trauma such as bruises or fractures, aspiration of rumen content, and abnormal odour in carcasses, and causing condemnations in meat inspection and lower meat quality. We investigated the statistical association of slaughter transport distance with these indices using meat inspection data from years 2004-2016, including inspection of 669,738 reindeer originating from Finnish reindeer herding areas. Results: Increased stress and decreased welfare of reindeer, as indicated by higher incidence of carcass condemnation due to bruises or fractures, aspiration of rumen content, or abnormal odour, were positively associated with systems involving shorter transport distances to abattoirs. Significant differences in incidence of condemnations were also detected between abattoirs and reindeer herding cooperatives. Conclusions: This study indicates that in particular the short-distance transports of reindeer merit more attention. While the results suggest that factors associated with long distance transport, such as driver education, truck design, veterinary supervision, and specialist equipment, may be favourable to reducing pre-slaughter stress in reindeer when compared with short distance transport systems, which occur in a variety of vehicle types and may be done by untrained handlers. Further work is required to elucidate the causal factors to the current results.
  • WSES-AAST Expert Panel; Coccolini, Federico; Moore, Ernest E.; Kluger, Yoram; Leppäniemi, Ari; Catena, Fausto (2019)
    Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
  • Meling, Emilia (Helsingin yliopisto, 2020)
    The objective of this study is to highlight traumas experienced by a student and to examine how the traumas arise in school context. I also examine what kind of support school was able to provide for the traumatized student. Purpose of this study is to provide knowledge and possible means for caretakers to encounter a traumatized child. In this study the voice is given to a young person who has been struggling with traumas during her time in school and her narrative is used to determine the student’s personal experiences of reconciling the traumas and school. The person who participated in this study was a former youth in a youth detention centre, whose traumas passed throughout her whole school time, especially throughout the secondary school and beginning of high school, which are the main subjects of this study. Purpose of this study is not to generalize, but to bring out this youth’s valuable story to the public by collecting relevant data. The study is a qualitative case study and collected material is used to highlight information about the factors that led to the traumas and in particular, what kind of support was available at school and what kind of support would have been needed. Data collection methods were observation, daily reports and open interviews. Analysis of the collected material was carried out according to methods of content analysis. Study results showed that traumas had significant links to a child’s well-being, learning and need for support at school. Trauma was caused by attachment problems and lack of basic needs of the child. My study is partly related to the attachment theory. Based on this, the early age problems of interaction seemed to affect later social life, psyche and coping with school. Problems reflected to school as social challenges and caused learning, concentration and behavioral problems. Hiding behind defenses, loneliness and labelled difference led to a decline in school motivation and performance. Support provided was not sufficient and all parties; teachers, classmates and the youth herself were exhausted. Traumas appear in school context in many ways in all areas of studying. In school context, there does not always seem to be enough time, means, skills or resources to face children who are severely traumatized and therefore mentally unstable.
  • Eränen, Liina Sofia Eleonoora (Helsingin yliopisto, 2021)
    Tutkielmassa tarkastellaan vuonna 1994 uponneen M/S Estonian pelastustöihin osallistuneiden autolauttojen henkilökunnan traumaperäisen stressin oireita (PTSD). Tutkielman tavoitteena on selvittää millainen yhteys trauman aikana koetulla pelolla, trauma-altistuksella sekä psykologiseen debriefing-tilaisuuteen osallistumisella on suuronnettomuuden aiheuttamien PTSD-oireiden voimakkuuteen. Teoriataustana hyödynnetään Janoff-Bulmanin perususkomusten teoriaa, jonka mukaan traumaattisia kokemuksia kohdanneiden yksilöiden voi olla haastava sisällyttää traumakokemuksiaan maailmankuvaansa, mikä johtaa tiedonkäsittelylle keskeisten perususkomusten pirstaloitumiseen. Teorian mukaan traumaattisille kokemuksille on tyypillistä, että yksilö joutuu kohtaamaan haavoittuvuutensa sekä ympäristönsä epäoikeudenmukaisuuden. Aineistona toimii vuonna 1995 poikkileikkausaineistona kerätty survey-kysely, johon ovat vastanneet Merimies Unionin jäsenet (N = 636), jotka työskentelivät pelastustöihin osallistuneilla autolautoilla onnettomuuden aikoihin. Tutkielmassa keskitytään tarkastelemaan onnettomuusyönä työvuorossa olleita henkilökunnan jäseniä (N = 261). Analyysimenetelminä käytettiin muun muassa eksploratiivista faktorianalyysia, Pearsonin korrelaatiokertoimia sekä usean muuttujan lineaarista regressioanalyysia, joilla selvitettiin tutkielmalle asetettuja hypoteeseja. Lisäanalyyseina hyödynnettiin moderaatioanalyysia sekä yksisuuntaista varianssianalyysia. Tulosten mukaan koettu pelko on tilastollisesti erittäin merkitsevästi yhteydessä PTSD-oireiden voimakkuuteen, oletusten mukaisesti. Onnettomuuden aikaisille järkyttäville tapahtumille altistumisen havaitaan olevan negatiivisessa yhteydessä koettujen PTSD-oireiden voimakkuuteen tilastollisesti jokseenkin merkitsevästi, mikä on ristiriidassa lähtöoletusten kanssa. Debriefing-tilaisuuteen osallistumisen havaitaan olevan tilastollisesti merkitsevästi positiivisessa yhteydessä koettujen PTSD-oireiden voimakkuuteen, mikä on niin ikään lähtöoletusten vastaista. Jatkotarkasteluissa havaittiin trauma-altistuksen ja debriefingiin osallistumisen moderoivan PTSD-oireiden voimakkuutta tilastollisesti merkitsevästi. Interaktiotermin visuaalisissa tarkasteluissa altistumattomilla ja debriefingiin osallistuneilla vastaajilla havaittiin olevan tilastollisesti merkitsevästi voimakkaampia PTSD-oireita verrattuna muihin vastaajiin. Altistuneiden joukossa PTSD-oireiden voimakkuus on keskiarvoisesti yhtä suurta, riippumatta siitä onko vastaaja osallistunut debriefingiin. Keskiarvoisesti vähiten oireita havaitaan altistumattomilla ja debriefingiin osallistumattomilla vastaajilla. Tutkielman tulokset tukevat aiemman tutkimuksen havaintoja trauman aikaisen pelon vaikutuksista uhrien PTSD-oireiden voimakkuuteen. Tulokset antavat lisäksi viitteitä siitä, ettei trauma-altistuksen ja PTSD-oireiden voimakkuuden yhteyttä voida pitää niin yksiselitteisenä kuin aiempi kirjallisuus on joskus olettanut. Jatkossa tulisi tarkastella laajemmin voiko yksilön toiminta, kuten muiden uhrien auttaminen trauman aikana muodostua oireilta suojaavaksi tekijäksi.Tutkielman tulosten sekä aiempien tutkimusten perusteella debriefingin käyttöä tulee tarkastella kriittisesti. Aiemmassa tutkimuksessa on harvemmin tarkasteltu trauma-altistuksen sekä debriefingin interaktioiden vaikutusta PTSD-oireiden voimakkuuteen. Tutkielman tulokset viittaavat kuitenkin siihen, että debriefing saattaa vaikuttaa eri tavoin eri trauma-altistuksen kohdanneiden uhrien toipumiseen. Tulosten perusteella keskiarvoisesti voimakkaimmista oireista kärsivät vähiten altistuneet sekä debriefingiin osallistuneet vastaajat. Traumoista toipumisen näkökulmasta olisi jatkossa tärkeää selvittää kenelle debriefingiin osallistuminen on hyödyllistä ja kenelle se saattaa olla haitallista.
  • Kangaslampi, Samuli; Garoff, Ferdinand; Peltonen, Kirsi (2015)
    Background: Millions of children worldwide suffer from posttraumatic stress disorder (PTSD) symptoms and other mental health problems due to repeated exposure to war or organized violence. Forms of cognitive-behavioral therapy (CBT) are the most commonly used treatment for PTSD and appear to be effective for children as well, but little is known about the mechanisms of change through which they achieve their effectiveness. Here we present the study protocol of a randomized controlled trial (RCT) studying the effectiveness and mechanisms of change of Narrative Exposure Therapy (NET), a CBT-based, manualized, short-term intervention for PTSD symptoms resulting from repeated traumatization, in immigrant children traumatized by war. Methods/Design: We are conducting a multicentre, pragmatic RCT in a usual care setting. Up to 80 9-17-year-old immigrant children who have experienced war and suffer from PTSD symptoms will be randomized into intervention (NET) and control (treatment as usual, TAU) groups of equal sizes. The effectiveness of NET treatment will be compared to both a waiting list and the parallel TAU positive control group, on the primary outcomes of PTSD and depressive symptoms, psychological distress, resilience, and level of cognitive performance. The effects of the intervention on traumatic memories and posttraumatic cognitions will be studied as potential mechanisms of change mediating overall treatment effectiveness. The possible moderating effects of peritraumatic dissociation, level of cognitive performance, and gender on treatment effectiveness will also be considered. We hypothesize that NET will be more effective than a waitlist condition or TAU in reducing PTSD and other symptoms and improving resilience, and that these effects will be mediated by changes in traumatic memories and posttraumatic cognitions. Discussion: The results of this trial will provide evidence for the effectiveness of NET in treating trauma-related symptoms in immigrant children affected by war. The trial will also generate insights into the complex relationships between PTSD, memory functions, posttraumatic cognitions and cognitive performance in children, and help guide the future development and implementation of therapeutic interventions for PTSD in children.
  • Coccolini, Federico; Stahel, Philip F.; Montori, Giulia; Biffl, Walter; Horer, Tal M.; Catena, Fausto; Kluger, Yoram; Moore, Ernest E.; Peitzman, Andrew B.; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo Pereira; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppäniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, Niccolo; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, Luca (2017)
    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.
  • Khirug, Stanislav; Soni, Shetal; Saez Garcia, Marta; Tessier, Marine; Zhou, Liang; Kulesskaya, Natalia; Rauvala, Heikki; Lindholm, Dan; Ludwig, Anastasia; Molinari, Florence; Rivera, Claudio (2021)
    A striking result from epidemiological studies show a correlation between low alcohol intake and lower incidence for ischemic stroke and severity of derived brain injury. Although reduced apoptosis and inflammation has been suggested to be involved, little is known about the mechanism mediating this effect in vivo. Increase in intracellular chloride concentration and derived depolarizing GABAAR-mediated transmission are common consequences following various brain injuries and are caused by the abnormal expression levels of the chloride cotransporters NKCC1 and KCC2. Downstream pro-apoptotic signaling through p75NTR may link GABAA depolarization with post-injury neuronal apoptosis. Here, we show that changes in GABAergic signaling, Cl− homeostasis, and expression of chloride cotransporters in the post-traumatic mouse brain can be significantly reduced by administration of 3% ethanol to the drinking water. Ethanol-induced upregulation of KCC2 has a positive impact on neuronal survival, preserving a large part of the cortical peri-infarct zone, as well as preventing the massive post-ischemic upregulation of the pro-apoptotic protein p75NTR. Importantly, intracortical multisite in vivo recordings showed that ethanol treatment could significantly ameliorate stroke-induced reduction in cortical activity. This surprising finding discloses a pathway triggered by low concentration of ethanol as a novel therapeutically relevant target.
  • Ax, M.; Reito, A.; Koskimaa, M.; Uutela, A.; Paloneva, J. (2019)
    Background and Aims: Traditionally, patients requiring an orthopedic emergency operation were admitted to an inpatient ward to await surgery. This often led to congestion of wards and operation rooms while, for less urgent traumas, the time spent waiting for the operation often became unacceptably long. The purpose of this study was to evaluate the flow of patients coded green in a traffic light-based coding process aimed at decreasing the burden on wards and enabling a scheduled emergency operation in Central Finland Hospital. Materials and Methods: Operation urgency was divided into three categories: green (>48 h), yellow (8-48 h), and red (
  • Coccolini, Federico; Montori, Giulia; Catena, Fausto; Kluger, Yoram; Biffl, Walter; Moore, Ernest E.; Reva, Viktor; Bing, Camilla; Bala, Miklosh; Fugazzola, Paola; Bahouth, Hany; Marzi, Ingo; Velmahos, George; Ivatury, Rao; Soreide, Kjetil; Horer, Tal; ten Broek, Richard; Pereira, Bruno M.; Fraga, Gustavo P.; Inaba, Kenji; Kashuk, Joseph; Parry, Neil; Masiakos, Peter T.; Mylonas, Konstantinos S.; Kirkpatrick, Andrew; Abu-Zidan, Fikri; Gomes, Carlos Augusto; Benatti, Simone Vasilij; Naidoo, Noel; Salvetti, Francesco; Maccatrozzo, Stefano; Agnoletti, Vanni; Gamberini, Emiliano; Solaini, Leonardo; Costanzo, Antonio; Celotti, Andrea; Tomasoni, Matteo; Khokha, Vladimir; Arvieux, Catherine; Napolitano, Lena; Handolin, Lauri; Pisano, Michele; Magnone, Stefano; Spain, David A.; de Moya, Marc; Davis, Kimberly A.; De Angelis, Nicola; Leppaniemi, Ari; Ferrada, Paula; Latifi, Rifat; Navarro, David Costa; Otomo, Yashuiro; Coimbra, Raul; Maier, Ronald V.; Moore, Frederick; Rizoli, Sandro; Sakakushev, Boris; Galante, Joseph M.; Chiara, Osvaldo; Cimbanassi, Stefania; Mefire, Alain Chichom; Weber, Dieter; Ceresoli, Marco; Peitzman, Andrew B.; Wehlie, Liban; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca (2017)
    Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.
  • Madanat, Rami; Makinen, Tatu J.; Ryan, Daniel; Huri, Gazi; Paschos, Nikolaos; Vide, Joao; FORTE Writing Comm (2017)
    Purpose The aim of this study was to compare differences in current orthopaedic and trauma training programs across Europe. Methods A questionnaire was sent to the FORTE (Federation of Orthopaedic Trainees in Europe) representatives of 25 different European countries, of which 18 responded. The questionnaire included demographic information and information concerning the structure of the training programs, including duration, selection, and mandatory training requirements. Results The number of trainees per specialist varied between countries from a ratio of 1:2 to 1:7. Residency was generally five to six years in all the countries. In more than half of the countries selection was interview-based. Nearly all countries utilized a logbook. About 80% of the participating countries had a final examination. When assessing the components of training it was found that only one country (the United Kingdom) had mandatory minimum requirements for (1) courses, (2) surgical procedures, (3) research and (4) leadership. Nearly 40% of the participating countries had only one or none of these four components as a mandatory training requirement. Conclusions There are many similarities in training programs, but some important differences remain in overall requirements and final qualification. The main limitation of this study was that we were unable to get data from all the European countries. FORTE will continue to serve as a forum for sharing best practices with the ultimate goal of improving and harmonizing the level of orthopaedic training across Europe. Future studies should aim to include further details about training programs as well as to include data from more countries.