322,909 research outputs found
Traumi toraco-addominali
No full textGli autori affrontano il tema complesso dei traumi toracoaddominali dal punto di vista fisiopatologico e del trattamento d'urgenza mirando soprattutto alle attuali visioni clinico terapeutiche
Intramural mesenteric venulitis. A new cause of intestinal ischaemia.
No full textVenous damage is an uncommon cause of intestinal ischaemia. We report on a 44-year-old woman who presented signs and symptoms of acute intestinal ischaemia requiring surgical treatment. Histological examination of the resected right colon showed features of an intramural lymphocytic venulitis with no other demonstrable causes of ischaemic injury of the bowel. Extramural mesenteric veins appeared dilated and congested, without evidence of thrombotic occlusion or of inflammatory involvement. The patient, who was not taking any long-term medication and had no clinical evidence of collagen-vascular disease, promptly recovered after surgery. Follow-up for 7 months with no recurrences suggested a self-limited or indolent process. We propose the name 'intramural mesenteric venulitis' for this condition and believe that it could represent one extreme (the microscopic variant or intramural phase) of the spectrum comprising entero-colic phlebitis and mesenteric inflammatory veno-occlusive disease. The immunohistochemical evidence of a marked preponderance of T phenotype in the perivenular lymphocytes suggests lymphocyte-mediated vascular damage as the pathogenesis of the lesion
il paziente chirurgico complesso
No full textgli autori prendendo in rassena i principali sistemi di punteggio relativi allo score di gravità dei pazienti,focalizzano il buon risultato terapeutico come funzione di un sistema comune gestionale più che alle singole capacità professionali
LATE POST-TRAUMATIC DIAPHRAGM RUPTURE IN A POLYTRAUMATIZED PATIENT: A CASE STUDY
No full textCase History: 50 years old male with traumatic brain, chest and skeletal injuries after a car crash, transferred from a peripheral hos- pital to our ED. A Total Body CT-Scan was performed. After the positioning of a trans-skeletal traction of the left leg and 12 h of observation in our ED, he was admitted to the floor with the diagnosis of: ‘‘Head Trauma, Small Left Pneumothorax, Multiple costal frac- tures, Pulmonary Contusions, Pneumomediastinum, Sternal Fracture, Left Acetabulum Fracture’’.
19 days after the trauma the patient underwent a reduction and fixa- tion of the acetabulum fracture without complications.
23 days after the trauma suddenly occurred a change in the clinical condition of the patient.
Clinical Findings: The patient appeared lethargic but aroused by oral stimulation, dyspnoeic, the hemodynamic was stable, no fever. At the clinical examination, the ventilation of the left hemithorax was remarkably reduced if compared to the contralateral; the patient reported pain to the palpation of the epigastrium and the bowel sounds were reduced.
Investigation/Results: Firstly a Chest X-Ray was performed: it showed the presence of the gastric bubble in the left thoracic sec- tion. Afterwards a Chest and Abdomen CT-scan was performed. Diagnosis: Late post-traumatic rupture of the left diaphragm (lacer- ation of 8-10 cm) with thorax herniation of the upper 3/4th of the stomach and of the omentum, associated with a massive left pneu- mothorax with shift of the mediastinum.
Therapy and Progressions: An emergency surgery for the reparation of the diaphragm rupture with a laparotomy approach was performed, followed by the positioning of a pleural drainage.
Comments: Although unexpected it is necessary to consider a late diaphragmatic injury in a patient involved in a car crash where there is the possibility of a traumatic-related increase of the abdomen pressure
The continuing medical education in the management of trauma tumors (corrected)
No full textAbstract BACKGROUND: The continuous medical education constitutes a great institutional project for the improvement of the relief quality in which he is affirming a variety of formative methodologies. Particularly must be uses specific systems for the adult education. MATERIALS AND METHODS: The project that is introduced it concerns a post-university formative run on the trauma with courses of target multidisciplinare or specialistic that answers to the need of specific knowledges on the whole run of clinical continuity of the patient. 236 students have currently participated, in non systematic way, developing interactive courses with a 40% of the hours devoted to the practical activity. RESULTS: The initial results of this activity show the validity of the model to increase his/her own abilities and to answer to the professional needs. CONCLUSIONS: The formative application appears directed to the development of coherent and systematic trials "problem directed" with strong involvement of the participants in practical activity and clinical experiences compariso
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