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   Table of Contents - Current issue
March-April 2019
Volume 52 | Issue 2
Page Nos. 39-70

Online since Thursday, April 18, 2019

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Geriatric trauma: A population-based study p. 39
Saint Shiou-Sheng Chen, Li-Chien Chien
Background: Geriatric trauma demands attention in aging societies. The trauma hospitalization rate gradually increases in elderly populations because they are more vulnerable to accidental injuries. High trauma admission rates among elderly groups led to further research about injury patterns and outcomes. We hope to understand more about the demographic patterns and mortality rate of geriatric trauma. Methods: Information about all injured in-hospital patients ≥64 years was retrieved from a claims dataset from 2007 to 2008 from the Bureau of National Health Insurance in Taiwan. Statistical analyses were conducted on the population-based dataset to discover the incidence, mortality rate, percentage of chronic illness, and associations among variables such as age group, gender, injury mechanism, injury severity, and mortality. Results: A total of 134,024 patients (28.2% of total inpatients' admissions) ≥64 years were admitted in 2007 and 2008; 45.0% were male patients, and 43.9% were rural residents. These resulted in 4120 deaths. Nearly 40.0% of patients had at least one chronic illness. Diabetes mellitus was the most common comorbidity (20.2%). Injury was most commonly caused by falls on the same level, followed by motorcycle accidents. A higher mortality rate was observed in the subgroup with higher injury severity scores. Logistic regression showed that the mortality rate was significantly higher in subgroups comprising patients aged 75–84 and >84 years, with higher Charlson index, and with mechanisms such as pedestrians hit by vehicles or falls from height. Conclusion: High trauma hospitalization rates among elderly people can be reduced. Choosing a target population for injury prevention policy is required to reduce the geriatric trauma hospitalization rate. A regionalized trauma system providing the elderly population with optimal trauma care is mandatory.
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Biodegradation patterns of injected composite bone cements in porcine vertebral bodies: A study using quantitative computed tomography p. 45
Chi-Ching Yeh, Chii-Jen Chen, Yun Tang, Kai-Chiang Yang, Chang-Chin Wu
Background: For vertebroplasty, newly synthesized bone cements are proposed to replace traditional polymethylmethacrylate (PMMA). Most inventors initially evaluated these newly developed cements in animal spine models. However, even these time- and work-consuming histological inspections performed meticulously by experienced hands, there are still lots of specimen lost during the processing procedures. Although the histological sections can reveal new bone formations and surrounding tissue reactions to implanted materials, it is difficult to identify the degradation processes of the injected cement. In fact, there is no standard method to quantify the volume changes of injected substitutes postoperation. Methods: Previously, we developed two new biodegradable cements and evaluated performances in fixed-volume and fixed-shaped holes in vertebral bodies of porcine lumbar spine. The animals were sacrificed and the retrieved spines were analyzed after 3 and 6 months. Herein, we further used computed tomography (CT) and three-dimensional CT (3D-CT) to quantitate volumes and biodegradation of cements inside vertebral bodies after previous attestation of CT findings. Exteriors of controls and injected materials were reconstructed with different Hounsfield units (HU); changes of HU as well as cement volumes were later calculated. Results: The results revealed that the volumes and shapes of these biodegradable cements can be determined by 3D-CT. After meticulous comparisons among gross specimens, histologies, and CT images, the different patterns observed in CT implied consistency among all three observations. Gradual reductions of HU and volumes of newly synthesized cements showed the degradability. Meanwhile, consistent HU and volumes of PMMA meant its inertness. Conclusion: CT imaging may be a preliminary, quantitative, and liable way for evaluating injectable bone cements in the vertebral bodies.
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A randomized clinical trial comparing a collagen-based composite dressing versus topical antibiotic ointment on healing full-thickness skin wounds to promote epithelialization p. 52
Hsin-Chung Tsai, Hui-Ching Shu, Li-Chuan Huang, Chuan-Mu Chen
Background: Acute traumatic wounds are a common and distressing event for patients presenting to plastic surgery clinics. There are no definitive conclusions regarding the benefits of collagen-based wound care products toward the application on full-thickness wounds compared to traditional ointment or gauze care. In this clinical trial, we aimed to define the potential benefits of collagen-based dressings on healing through the comparison of collagen-based composite dressings with antibiotic ointment dressings. Methods: This was a randomized two-tailed controlled clinical trial. The acute full-thickness wounds underwent wound cleansing, debridement, and were secured with different dressings in both experimental and control groups. The wounds were subsequently photographed weekly, and the wound areas were calculated using ImageJ software to evaluate wound healing rate. Results: The results demonstrate that the collagen-based triple layer composite dressings which consisted of silver sheet, collagen sponge, and foam films promoted better epithelialization and healing than antibiotic ointment treatment. Collagen supplementation improved wound healing and epithelialization by providing a dry environment during the late stage of wound healing. Conclusion: We demonstrated that the collagen-based triple layer wound dressing could potentially increase the healing rate when used for traumatic full-thickness wound care compared to the conventional antibiotic ointment dressing, providing a new prospective in the future applications of wound care.
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A simple technique to create spur in loop colostomy p. 57
Gurmeet Singh, Anand Pandey, Jiledar Rawat, Sudhir Singh
A colostomy is one of the most popular techniques used as a protective maneuver for a distal anastomosis and/or temporary fecal diversion loop colostomy is used mainly for fecal diversion so as to protect the distal bowel. We report a new simple technique for the creation of mucosal spur in between the proximal and distal stoma without using either a tube or skin flap. The essence of this technique is the creation of mucosal spur by placing two additional sutures in the bridge in between the proximal and distal stoma. The placement of sutures creates the spur and helps in defunctioning of distal stoma. Seventeen patients were operated by this technique over a period of 1 year. The creation of the mucosal spur was excellent. There was no requirement of a tube or skin flap in any of the patients in the follow-up. There was no problem of loss of spur over a period. This is a simple technique, which needs few additional sutures apart from the necessary sutures needed for maturation of colostomy.
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Periorbital purulent drainage of resulting from bacterial pansinusitis p. 60
Chia-Ming Lin, Pin-Keng Shih
Periorbital cellulitis is much more common in younger children than in adolescents or adults, and most cases of uncomplicated periorbital cellulitis can be treated with antibiotics alone. Here, we report a case of a 53-year-old man with periorbital purulent discharge. Computed tomography imaging revealed pansinusitis. Pus culture isolated a pathogen of Streptococcus constellatus, but it was refractory to 2 weeks of antibiotic therapy with amoxicillin–clavulanate. The patient underwent debridement and functional endoscopic sinus surgery, followed by 10 days of hyperbaric oxygen treatment. The above antibiotic was changed to full-dose intravenous clindamycin. Two weeks after the surgery, the patient was discharged from the hospital. At 1-month follow-up, no purulent discharge was noted; however, mild left-eyelid contracture was observed. This study suggested that if conservative therapy for periorbital purulent discharge in an adult is not effective, progressive treatment, including surgery, should be considered.
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Closing of postoperative integument, skull bones and dura defects p. 63
Jia Wei Lin, Evgeny G Sobakar, Oleg V Ivanov, Evgeny V Semichev
This article describes skull defect plastic, which is especially relevant, and in particular, cases, is a great challenge for surgeons. The clinical case described covers formation of a defect in the cranial vault bones, complicated by skin integument, skull bones, and the dura matter defects.
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Innovative methods of maintaining operation records using the online Google spreadsheet p. 66
BA Ramesh, Singaravelu Viswanathan, Souparna Manjunath, Deyonna Deepthi Fernandez, Candy Priyadarshini, Gaurav B Shetty
Background: Maintaining an operation record in any surgical department is mandatory. The current method is to make entries in a designated register manually. However, this method has disadvantages such as space occupancy, high maintenance cost, and difficulty in record compilation. Proper storing of medical records is necessary for future reference. We found that using the free online, Google spreadsheet for maintaining surgical records is an innovative and effective method. Methods: Online Google spreadsheet entry September 2017 to August 2018 is compared with manual entry done from September 2016 to August 2017. Results: This online method has the following advantages: fewer errors, low cost, free maintenance, and easy record compilation as per requirements. Finally, filters can be applied, and separate numbers for each category can be obtained. Conclusion: The proposed method is useful, low cost, and versatile way of storing and retrieving operative records.
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Occult medullary breast carcinoma in a male p. 70
Mahmood Dhahir Al-Mendalawi
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