Neurologico Spinale Medico Chirurgico Journal
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Diagnostic validity of Thoracic trauma severity score in patient with blunt thoracic trauma for predicting mortality rate
No full textIntroduction: The high incidence of blunt thoracic trauma is still a serious concern in emergency services. Mild to severe cases of blunt thoracic trauma that come to the emergency department are not those that can be considered simple but need to be reviewed for the possibility that can lead to the occurrence of advanced complications. This study aims to predict mortality in patient with blunt thoracic trauma with TTS (Thoracic trauma severity) score.Patients and Methods: This is a retrospective study with 52 subjects of blunt thoracic trauma patients treated at our University Hospital from January 2016 to May 2017. Eligible data were collected from medical record analyzed by receiver operating characteristics curve and cross tabulation. Results: The age of the subjects are 48.03±15.62, with male 42 subjects (80.8%) and female ten subjects (19.2%). The mean point of Thoracic trauma severity score (TTSS) was 8.32 ± SD: 2.69. The outcome was three patients dead (5.8%) and 49 patients discharged (94,2%). The sensitivity of TTSS 100 %, specificity 89.7%, positive predictive value (PPV) 37.5%, negative predictive value (NPV) 100%, and accuracy rate 90.3%. Highly sensitivity and specificity results for Thoracic Trauma Severity Score is valid for the screening of Blunt Thoracic Trauma.Conclusion: At 11.5 cut-off point, the TTSS was an excellent tool to predict the mortality rate of patients with blunt thoracic trauma. It has a 100% sensitivity and 89.7% specificity, as well as 37.5% PPV and 100% NPV
Clinical predictors of intra-abdominal lesions in blunt abdominal trauma patients with the conservative treatment
No full textBackground: Blunt abdominal trauma has a high rate of morbidity and mortality. Assessment of specific clinical symptoms such as abdominal traces, abdominal pain, gross hematuria, pelvic fracture, systolic blood pressure and pulse rate in blunt abdominal trauma patients can predict the presence of intra-abdominal injury, so the use of CT Scan in diagnostics may be selective. The purpose of this study was to determine the predictors of intra-abdominal lesions in patients with blunt abdominal trauma who were treated conservatively.Material and Method: This study used a cross-sectional design. Samples were taken from the medical records, from January 2015 to December 2016. The total sample was 124 patients, were analyzed using Chi-square and logistic regression. This study has passed ethical clearance from the institutional review board of our UniversityResult: The results showed the mean age of patients was 33 years, the majority of patients were male (74.2%), and a negative CT scan was 39.5%. The clinical predictors of intra-abdominal lesions in CT scan of blunt abdominal trauma patients were: abdominal traces (OR: 11.252; 95% CI: 3.257-38.867; p <0.001), abdominal pain with VAS≥5 (OR : 92.968; 95% CI: 14.604-591,837; p <0.001); and gross hematuria (OR: 9.377; 95% CI: 1.539-57.115; p = 0.015). Pelvic fracture, systolic blood pressure, and pulse rate were not statistically proven.Conclusion: Abdominal traces, abdominal pain, and gross hematuria are clinical predictors of intra-abdominal lesions. Predictors should be taken into consideration in decision making to perform an abdominal CT scan in blunt abdominal trauma patients treated conservatively
Diagnostic validity of blunt abdominal trauma scoring system (BATSS) on blunt adominal trauma in Sanglah General Hospital, Denpasar, Bali
No full textBackground: Abdominal trauma is the third leading cause of death in trauma patients and can be found in about 7-10% of the total number of trauma cases. The Blunt Abdominal Trauma Scoring System (BATSS) provides a high-accuracy score system for diagnosing injury to intra-abdominal organs in blunt abdominal trauma patients based on clinical features, such as patient history, physical examination, and Focused Assesment with Sonography for Trauma (FAST). This study aimed to determine the validity of the diagnostic value of BATSS score in cases of blunt abdominal trauma.Method: This research was conducted at Sanglah General Hospital, Denpasar with a total sample of 44 patients. The subjects were abdominal blunt trauma patients who meet the inclusion and exclusion criteria. This study was a retrospective study to determined the validity of the BATSS score.Result: Of the 44 patients, BATSS score ³12 was found at 34 (77.3%) and BATTS <12 scores of 10 (22.7%). For groups with BATSS score ³12, there were 32 (94.11%) patients. As for the group with BATSS score <12, there were 3 (30%) patients with organ rupture. A validity test of BATSS score obtained showed 91.4% sensitivity, 77.77% specificity, positive predictive value 94.1%, negative predictive value 70%.Conclusion: BATSS can be a tool of early identification and stratification of patients at high risk of the occurrence of intra-abdominal organ injury due to blunt abdominal trauma
Palliative treatment for multiple spinal metastasis in patient with ovarian cancer
No full textOvarian cancer is the fourth most common type of female cancer and the fifth leading cause of cancer death in women. It is the fourth most common malignancy in women. Management varies depending on the patient condition, so one patient can undergo aggressive decompression and stabilization followed by adjuvant therapy, while others may respond to medication and supportive care. The decision to pursue radical surgical treatment is complex, but the indications are becoming clearer. These include radioresistant tumors, obvious spinal instability, clinically significant neural compression secondary to retropulsed bone or from spinal deformity, intractable pain unresponsive to nonoperative measures, and radiation failure
Diagnostic validity of PULP (peptic ulcer perforation) score in predicting mortality in patient with operated perforated peptic ulcer in Sanglah Hospital- Denpasar
No full textBackground: Perforated peptic ulcer (PPU) is one of the most common non-traumatic emergency cases in the emergency unit, and have a high mortality rate, more than 70% in the elderly. Accurate and early identification of high-risk surgical patients with PPU is important for triage and risk stratification. The objective of this study was to evaluate the mortality in patients with operated PPU.Methods: Between January 2015 to December 2016, 50 consecutive patients with PPU who performed laparotomy were studied retrospectively. This study was a diagnostic test to evaluate the validity of PULP (Peptic Ulcer Perforation) score to predict mortality in patient with operated PPU and determine the best cut-off point. Presentation ≥ or < 24 hours, age of 65 years old, the presence of preoperative shock, ASA score, the presence of AIDS or active malignancy, liver failure, concomitant use of steroids and serum creatinine > 14.7 g/dL were evaluated in PULP score.Results: The cut-off point for PULP the score in the present study is > 7, based on the optimal cut-off value, patients could be divided into low-risk patients (a score of < 7 points), and high-risk patients (a score of > 7 points). PULP score had 91.7% sensitivity, 65.4% specificity, and 78% accuracy in this study. Positive predictive value and negative predictive the values were 71% and 89.9%.Conclusion: The PULP score is sensitive to predict the mortality risk in patients operated for perforated peptic ulcer and can assist in risk stratification and triage.
Surgery of Intramedullary Tumours
No full textSurgery still offers a cure to the majority of intramedullary tumours. The challenge of the surgery is taking out the tumour while preserving the function. Very often the patient has a huge tumour with very minimal symptoms, such as mild numbness. The slow growth of the tumour nature provides enough time for the cord fibres to adapt accordingly. Usually, the motor function is preserved and most of the pathologies are benign. For this reasons, the majority of cases have good long-term tumour control. The functional outcome is depending on the preoperative functional state, especially for motor function. The patient should be educated prior to surgery, especially to anticipate the post-surgical rehabilitation period. The surgical technique should preserve the motor function, but the fine movement usually gets worst for several months after surgery and slowly recover within 6 months. We share our experience of 45 surgical cases with intramedullary tumour (14F;31M), the pathologies distributions are 20 ependymomas, 8 astrocytomas (1/8 anaplastic astrocytoma), 7 cavernomas, 8 hemangioblastomas, 1 glioblastoma multiforme, and 1 tuberculoma. The location distribution varied from 27 at the cervical cord, 11 thoracal, 4 thoracolumbal, and 3 MO-upper cervical. The surgical outcome for all cases experienced sensory changes and recovered over 6 months. Almost all cases experienced some degree of spasticity and fine movement difficulty and they are improving over 6 months. Motor strength is usually preserved. One case of GBM, improve gradually for the first two months then followed by the disease course regardless of the treatment. The tuberculoma case required one year to recover her neurological function with adequate treatment.
EXCISION OF GIANT CELL TUMOR FOLLOWED BY RECONSTRUCTION OF DISTAL RADIUS USING FREE VASCULARIZED FIBULAR GRAFT
No full textGiant cell tumor (GCT) of the distal radius is a rare and unpredictable lesion. The aim of treatment is complete removal of the tumor and preservation of the maximum function of the extremity. Lower rates of local recurrence have been noted after wide resection of the diseased bone. Its standard treatment has ranged from surgical curettage to wide resection. One method for closing the defect is using the head of the fibula as a substitute for the distal radius. The healing of vascularized fibular graft is very quick and without bone resorption. Thus, in the procedure for reconstruction and limb salvage after bone tumor resection of the distal radius, the free vascularized fibular graft with the fibular head is an ideal substitute. This case report will show a patient with GCT that successfully treated by an excision of GCT followed by reconstruction of distal radius using free vascularized fibular graft
Tethered Cord Syndrome
No full textTethered cord syndrome (TCS) is a clinical condition of various origins, which comprises of progressive neurological, urological, and orthopaedic dysfunction, because of congenital fixation or tethering of the distal spinal cord by the terminal filum. It is believed that, if the filum elasticity is compromised by either fatty infiltration or abnormal thickening, the spine movement may cause stress upon the conus, resulting in TCS.Patients with symptomatic TCS can present with a wide variety of signs and symptoms in combination with cutaneous, orthopaedic, spinal, anorectal, and urological abnormalities. The common clinical presentations include the presence of cutaneous signs associated with open septal defects, neurogenic bladder with incontinence or urinary tract infection, leg or foot weakness, numbness and/or spasticity, differences in leg or foot length, deformities of the foot, spinal deformities, and back and leg pain.Neuroimaging is used to confirm when there is suspicion of TCS. Magnetic resonance imaging is the modality of choice in visualizing the level of the conus medullaris and for identifying a thickened and/or fatty filum.The fundamental goals of surgical intervention in TCS are to prevent future deficits in the asymptomatic patient and to improve or stabilize deficits in the symptomatic patient. These two goals are based on the fact that sectioning of the terminal filum can be done safely with minimal risk and a very low rate of morbidity. The reported complications of surgery are cerebrospinal fluid leakage (most common), wound infection, meningitis, bladder dysfunction, and neurological injury.
RISK FACTORS OF HIGH INTRACRANIAL PRESSURE AND THE RELATED OUTCOMES IN SUBJECTS WITH SEVERE HEAD INJURY IN SANGLAH GENERAL HOSPITAL DENPASAR
No full textoai:ojs.nsmc.balijournals.org:article/123Background: Severe head injury management target is to prevent the secondary brain injury characterized by deterioration in the outcome. High intracranial pressure (ICP) and low cerebral perfusion pressure (CPP) could cause unfavourable outcomes which is influenced by many factors, such as hypoxia and haemorrhage lesions pictured on head CT scan. This study analyzes various risk factors that can lead to increased ICP and the influence of high ICP on the outcome.Methods: This study is a prospective cohort, involving 42 consecutive subjects with severe head injury patients from June to October 2016. The subjects underwent examination for blood pressure, blood gas analysis, and head CT scan. ICP monitoring was then performed and the outcome was assessed using the Glasgow Outcome Scale score when the patient was discharged. In this study, risk factors such as hypoxia, hypotension, and subarachnoid haemorrhage (SAH) were analyzed. Statistical analysis was performed with SPSS 27 with a confdence interval of 95%.Result: There were two risk factors that signifcantly influenced the increase of ICP, which were hypotension (RR 0.27; 95CI 0.095-0.775; p<0.001) and hypoxia (RR 0.125; 95CI 0.034-0.457; p<0.001). High ICP value ≥ 20 mmHg was associated with an unfavourable outcome(RR 2.28; 95CI 1.31-3.98; p<0.001).Conclusion: Hypoxia and hypotension were two risk factors that signifcantly influenced the increase of ICP, where high ICP caused the unfavourable outcome
Management of The Cervical Spine Tuberculosis
No full textTuberculosis of the cervical spine is a rare clinical condition (10%), most commonly affected lower thoracic region (40-50% of the cases). Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Characteristically, there is a destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. For the diagnosis of spinal tuberculosis, magnetic resonance imaging is more sensitive than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates an involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Anti-tuberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. With early diagnosis and early treatment, the prognosis is generally good