[Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures].

Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and international publications, the dramatically changing epidemiology of pelvic ring fractures, further developments in diagnostics and the changes in operative procedures over time could be demonstrated. Last but not least the now well-established diagnostic and therapeutic algorithms for pelvic ring fractures, which could be derived from the information collated in registry studies, reflect the clinical impact of the registry.

Psychic treatment of nervous disorders : (the psycho-neuroses and their moral treatment),

Mode of access: Internet.

Treatment delays in paediatric dento-alveolar trauma at a tertiary referral hospital

Background: Paediatric dento-alveolar trauma is a common event. Delays in treatment can have adverse effects on long term outcomes and the aim of this study was to quantify the treatment delays in paediatric dento-alveolar trauma in a tertiary referral hospital. Methods: All cases of paediatric dento-alveolar trauma over a two-year period from July 2000 to June 2002 were identified and the charts were reviewed retrospectively. All children presenting the emergency department with dento-alveolar trauma within 48 hours of injury during the time period were included. Results: Forty-three patients were identified. The average age was 5.51 years, though there was a bias towards one and two year olds. Males were injured 1.5 times more frequently than females. There was an average delay of 9.6 hours between injury and treatment for all patients. Transit time from outside practitioners to hospital and waiting times in hospital made up the greatest delays. Children injured an average of 2.37 teeth and only 14 per cent were uncomplicated crown fractures. Conclusions: Children who present to children's hospitals for treatment of dento-alveolar trauma have more severe injuries than those treated elsewhere. They have large but potentially reducible delays between injury and treatment.

A dyadic perspective on genito-pelvic pain : trauma antecedents and treatment effectiveness

La vestibulodynie provoquée (VP) est la forme la plus répandue de douleur génito-pelvienne/trouble de la pénétration et la cause la plus fréquente de douleur vaginale chez les femmes pré-ménopausées. Les femmes qui en souffrent rapportent plus de détresse psychologique ainsi qu’un fonctionnement sexuel appauvri, une diminution de la fréquence des activités sexuelles et du plaisir, et plus d’attitudes négatives à l’égard de la sexualité. Les recherches portant sur les couples souffrant de VP ont montré le rôle prépondérant des variables relationnelles dans la modulation des conséquences sexuelles et psychologiques pour les femmes et leurs partenaires. Cependant, aucune analyse dyadique n’a été appliquée au facteur de risque étiologique le plus robuste, soit la maltraitance durant l’enfance. Par ailleurs, malgré des recommandations répétées pour inclure le partenaire dans le traitement psychologique pour la VP, aucune étude à ce jour n’a examiné l’efficacité d’une psychothérapie qui inclut systématiquement le partenaire et dont la cible est le couple. L’objectif général de cette thèse a été d’utiliser une perspective dyadique afin d’examiner les antécédents de maltraitance et l’efficacité d’une intervention conçue pour améliorer les issues des couples souffrant de VP. Le premier article vise à examiner les liens entre la maltraitance durant l’enfance des femmes souffrant de VP et leurs partenaires, et leur fonctionnement sexuel, leur ajustement psychologique, leur satisfaction conjugale et enfin avec la douleur rapportée par les femmes durant les relations sexuelles. Quarante-neuf couples souffrant de VP ont complété des questionnaires auto-rapportés. La maltraitance durant l’enfance chez les femmes était associée à un fonctionnement sexuel plus faible chez les femmes et les hommes, une augmentation de l’anxiété chez les femmes seulement, et une douleur affective accrue durant les relations sexuelles. La maltraitance durant l’enfance chez les hommes était associée à un fonctionnement sexuel plus faible, moins de satisfaction conjugale, plus d’anxiété chez les femmes et les hommes, et une douleur affective accrue durant les relations sexuelles rapportée par les femmes. En se basant sur les recommandations issues des études empiriques, une thérapie cognitive et comportementale pour les couples (TCCC) souffrant de VP a été développée. Le deuxième article présente les résultats d’une étude pilote testant son efficacité, fidélité et faisabilité potentielles. Neuf couples ont complété des questionnaires auto-rapportés pré- et post-traitement. La TCCC de 12 rencontres était manualisée. Les femmes ont rapporté une amélioration significative de la douleur, du fonctionnement et de la satisfaction sexuels, et les partenaires ont rapporté une amélioration significative de leur satisfaction sexuelle. Les couples ont rapporté des niveaux élevés de satisfaction quant à la psychothérapie, et les psychothérapeutes ont rapporté suivre le manuel de traitement de manière fidèle. Le troisième article, s’appuyant sur les résultats prometteurs de l’étude pilote, décrit le protocole de recherche pour un essai clinique randomisé mesurant l’efficacité de la TCCC comparée à une intervention médicale de première ligne, la lidocaïne topique, pour le traitement de la VP. Enfin, les implications cliniques et théoriques de la thèse sont discutées.

Liver trauma. Diagnosis and treatment

The authors summarize the essential steps in liver surgery. Modern imaging techniques are of great help in establishing a circumstantiated diagnosis of post-traumatic lesions of the intra-abdominal parenchymatous organs, and especially the liver. Such diagnosis must always be based on the AAST (American Association for the Surgery of Trauma) classification, essential for a correct approach. Each therapeutic choice must be based on a careful clinical evaluation to establish whether emergency exploration of the abdomen or simple patient monitoring is indicated. Organ injuries and consequent hemoperitoneum must be found and quantified. In any case, diagnosis and treatment must only begin once all measures have been taken to ensure the maintenance of vital functions and the normalization of the main blood chemistry parameters.

A dyadic perspective on genito-pelvic pain : trauma antecedents and treatment effectiveness

La vestibulodynie provoquée (VP) est la forme la plus répandue de douleur génito-pelvienne/trouble de la pénétration et la cause la plus fréquente de douleur vaginale chez les femmes pré-ménopausées. Les femmes qui en souffrent rapportent plus de détresse psychologique ainsi qu’un fonctionnement sexuel appauvri, une diminution de la fréquence des activités sexuelles et du plaisir, et plus d’attitudes négatives à l’égard de la sexualité. Les recherches portant sur les couples souffrant de VP ont montré le rôle prépondérant des variables relationnelles dans la modulation des conséquences sexuelles et psychologiques pour les femmes et leurs partenaires. Cependant, aucune analyse dyadique n’a été appliquée au facteur de risque étiologique le plus robuste, soit la maltraitance durant l’enfance. Par ailleurs, malgré des recommandations répétées pour inclure le partenaire dans le traitement psychologique pour la VP, aucune étude à ce jour n’a examiné l’efficacité d’une psychothérapie qui inclut systématiquement le partenaire et dont la cible est le couple. L’objectif général de cette thèse a été d’utiliser une perspective dyadique afin d’examiner les antécédents de maltraitance et l’efficacité d’une intervention conçue pour améliorer les issues des couples souffrant de VP. Le premier article vise à examiner les liens entre la maltraitance durant l’enfance des femmes souffrant de VP et leurs partenaires, et leur fonctionnement sexuel, leur ajustement psychologique, leur satisfaction conjugale et enfin avec la douleur rapportée par les femmes durant les relations sexuelles. Quarante-neuf couples souffrant de VP ont complété des questionnaires auto-rapportés. La maltraitance durant l’enfance chez les femmes était associée à un fonctionnement sexuel plus faible chez les femmes et les hommes, une augmentation de l’anxiété chez les femmes seulement, et une douleur affective accrue durant les relations sexuelles. La maltraitance durant l’enfance chez les hommes était associée à un fonctionnement sexuel plus faible, moins de satisfaction conjugale, plus d’anxiété chez les femmes et les hommes, et une douleur affective accrue durant les relations sexuelles rapportée par les femmes. En se basant sur les recommandations issues des études empiriques, une thérapie cognitive et comportementale pour les couples (TCCC) souffrant de VP a été développée. Le deuxième article présente les résultats d’une étude pilote testant son efficacité, fidélité et faisabilité potentielles. Neuf couples ont complété des questionnaires auto-rapportés pré- et post-traitement. La TCCC de 12 rencontres était manualisée. Les femmes ont rapporté une amélioration significative de la douleur, du fonctionnement et de la satisfaction sexuels, et les partenaires ont rapporté une amélioration significative de leur satisfaction sexuelle. Les couples ont rapporté des niveaux élevés de satisfaction quant à la psychothérapie, et les psychothérapeutes ont rapporté suivre le manuel de traitement de manière fidèle. Le troisième article, s’appuyant sur les résultats prometteurs de l’étude pilote, décrit le protocole de recherche pour un essai clinique randomisé mesurant l’efficacité de la TCCC comparée à une intervention médicale de première ligne, la lidocaïne topique, pour le traitement de la VP. Enfin, les implications cliniques et théoriques de la thèse sont discutées.

Minimal Invasive Ostheosintesis For Treatment Of Diaphiseal Transverse Humeral Shaft Fractures.

To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.

Management Of Severe Thoracic Impalement Trauma Against Two-wheeled Horse Carriage: A Case Report And Literature Review.

Thoracic injuries in general are of great importance due to their high incidence and high mortality. Thoracic impalement injuries are rare but severe due to the combination of cause, effect and result. This study's primary objective is to report the case of a young man who was impaled by a two-wheeled horse carriage shaft while crashing his motorcycle in a rural zone. An EMT-B ferry was called at the crash scene and a conscious patient was found, sustaining a severe impalement injury to the left hemithorax, suspended over the floor by the axial skeleton with the carriage shaft coming across his left chest. As a secondary objective, a literature review of thoracic impalement injuries is performed. Cases of thoracic impalement injury require unique and individualized care based on injury severity and affected organs. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management. In penetrating trauma, it is essential not to remove the impaled object, so that possible vascular lesions remain buffered by the object, avoiding major bleeding and exsanguination haemorrhage. Severed impaled thoracic patients should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment. High-energy thoracic impalement injuries are rare and hold a high mortality rate, due to the complexity of trauma and associated injuries such as thoracic wall and lung lesions. Modern medicine still seems limited in cases of such seriousness, not always with satisfactory results.

The Biopsychosocial Spiritual Model Applied To The Treatment Of women With Breast Cancer, Through Rime Intervention (relaxation, mental Images, Spirituality).

This postdoctoral study on the application of the RIME intervention in women that had undergone mastectomy and were in treatment, aimed to promote psychospiritual and social transformations to improve the quality of life, self-esteem and hope. A total of 28 women participated and were randomized into two groups. Brief Psychotherapy (PB) (average of six sessions) was administered in the Control Group, and RIME (three sessions) and BP (average of five sessions) were applied in the RIME Group. The quantitative results indicated a significant improvement (38.3%) in the Perception of Quality of Life after RIME according to the WHOQOL, compared both to the BP of the Control Group (12.5%), and the BP of the RIME Group (16.2%). There was a significant improvement in Self-esteem (Rosenberg) after RIME (14.6%) compared to the BP of the Control Group (worsened 35.9%), and the BP of the RIME Group (8.3%). The improvement in well-being, considering the focus worked on (Visual Analog Scale), was significant in the RIME Group (bad to good), as well as in the Control Group (unpleasant to good). The qualitative results indicated that RIME promotes creative transformations in the intrapsychic and interpersonal dimensions, so that new meanings and/or new attitudes emerge into the consciousness. It was observed that RIME has more strength of psychic structure, ego strengthening and provides a faster transformation that BP, therefore it can be indicated for crisis treatment in the hospital environment.

Management of a complex dentoalveolar trauma: a case report

This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

A randomized trial comparing hormone replacement therapy (HRT) and HRT plus calcitriol in the treatment of postmenopausal osteoporosis with vertebral fractures: Benefit of the combination on total body and hip density

We report a prospective, randomized, multi-center, open-label 2-year trial of 81 postmenopausal women aged 53-79 years with at least one minimal-trauma vertebral fracture (VF) and low (T-score below 2) lumbar bone mineral density (BMD). Group HRT received piperazine estrone sulfate (PES) 0.625 - 1.25 mg/d +/- medroxyprogesterone acetate (MPA) 2.5 - 5 mg/d,- group HRT/D received HRT plus calcitriol 0.25 mug bd. All with a baseline dietary calcium (Ca) of < I g/d received Ca carbonate 0.6 g nocte. Final data were on 66 - 70 patients. On HRT/D, significant (P < 0.001) BNID increases from baseline by DXA were at total body - head, trochanter, Ward's, total hip, inter-trochanter and femoral shaft (% group mean Delta 4.2, 6.1, 9.3. 3.7. 3.3 and 3.3%, respectively). On HRT, at these significant Deltas were restricted to the trochanter and sites. si Wards. Significant advantages of HRT/D over HRT were in BMD of total body (- head), total hip and trochanter (all P = 0.01). The differences in mean Delta at these sites were 1.3, 2.6 and 3.9%. At the following, both groups Improved significantly -lumbar spine (AP and lateral), forearm shaft and ultradistal tibia/fibula. The weightbearing, site - specific benefits of the combination associated with significant suppression of parathyroid hormone-suggest a beneficial effect on cortical bone. Suppression of bone turnover was significantly greater on HRT/D (serum osteocalcin P = 0.024 and urinary hydroxyproline/creatinine ratio P = 0.035). There was no significant difference in the number of patients who developed fresh VFs during the trial (HRT 8/36, 22%; HRT/D 4/34, 12% - intention to treat); likewise in the number who developed incident nonvertebral fractures. This Is the first study comparing the 2 treatments in a fracture population. The results indicate a significant benefit of calcitriol combined with HRT on total body BMD and on BNID at the hip, the major site of osteoporotic fracture.

Endovascular Treatment for Chronic Arteriovenous Fistula Between Renal Artery and Inferior Vena Cava: Image in Vascular Surgery

Arteriovenous fistula involving renal artery and inferior vena cava are rare. We report the case of a 47-year-old woman with a chronic arteriovenous fistula between right renal artery and inferior vena cava due to a penetrating trauma. Another finding was a vena cava aneurysm caused by the fistula. The patient was successfully treated with a covered stent in the renal artery. Diagnosis and postoperative control have been documented with CT scan. Endovascular techniques may be effective and minimally invasive option for treatment and renal preservation in renal-cava arteriovenous fistulae.

Facial Palsy After Blunt Trauma and Without Facial Bone Fracture

A 14-year-old patient had a low-energy facial blunt trauma that evolved to right facial paralysis caused by parotid hematoma with parotid salivary gland lesion. Computed tomography and angiography demonstrated intraparotid collection without pseudoaneurysm and without radiologic signs of fracture in the face. The patient was treated with serial punctures for hematoma deflation, resolving with regression and complete remission of facial paralysis, with no late sequela. The authors discuss the relationship between facial nerve traumatic injuries associated or not with the presence of facial fractures, emphasizing the importance of early recognition and appropriate treatment of such cases.

Laparoscopic Duodenal-Jejunal Bypass for the Treatment of Duodenal Obstruction Caused by Annular Pancreas: Description of a Surgical Technique

Annular pancreas is a rare congenital anomaly, which is only surgically treated in symptomatic cases. Surgical treatment consists of bypassing the duodenal transit by gastrojejunal or duodenal-jejunal anastomosis. In the absolute majority of published cases, laparotomy is the most widely used access technique. The aim of this article is to report a case of an annular pancreas and describe the technical steps involved in carrying out a laparoscopic duodenal-jejunal anastomosis, for correction of the duodenal obstruction. The patient`s recovery was uneventful; she was discharged on the fourth postoperative day and remained asymptomatic for the 2-year, outpatient follow-up period. Laparoscopic duodenal-jejunal bypass is shown to be feasible and safe, and produce less surgical trauma, when carried out by an experienced surgeon who is duly trained and familiar with the laparoscopic technique.

Effects of hyperbaric oxygen treatment on auditory hair cells after acute noise damage

Acute acoustic trauma (AAT) is a sudden sensorineural hearing loss caused by exposure of the hearing organ to acoustic overstimulation, typically an intense sound impulse, hyperbaric oxygen therapy (HOT), which favors repair of the microcirculation, can be potentially used to treat it. Hence, this study aimed to assess the effects of HOT on guinea pigs exposed to acoustic trauma. Fifteen guinea pigs were exposed to noise in the 4-kHz range with intensity of 110 dB sound level pressure for 72 h. They were assessed by brainstem auditory evoked potential (BAEP) and by distortion product otoacoustic emission (DPOAE) before and after exposure and after HOT at 2.0 absolute atmospheres for 1 h. The cochleae were then analyzed using scanning electron microscopy (SEM). There was a statistically significant difference in the signal-to-noise ratio of the DPOAE amplitudes for the 1- to 4-kHz frequencies and the SEM findings revealed damaged outer hair cells (OHC) after exposure to noise, with recovery after HOT (p = 0.0159), which did not occur on thresholds and amplitudes to BAEP (p = 0.1593). The electrophysiological BAEP data did not demonstrate effectiveness of HOT against AAT damage. However, there was improvement of the anatomical pattern of damage detected by SEM, with a significant reduction of the number of injured cochlear OHC and their functionality detected by DPOAE.