Metabolic changes after polytrauma: an imperative for early nutritional support

Major trauma induces marked metabolic changes which contribute to the systemic immune suppression in severely injured patients and increase the risk of infection and posttraumatic organ failure. The hypercatabolic state of polytrauma patients must be recognized early and treated by an appropriate nutritional management in order to avoid late complications. Clinical studies in recent years have supported the concept of "immunonutrition" for severely injured patients, which takes into account the supplementation of Ω-3 fatty acids and essential aminoacids, such as glutamine. Yet many aspects of the nutritional strategies for polytrauma patients remain controversial, including the exact timing, caloric and protein amount of nutrition, choice of enteral versus parenteral route, and duration. The present review will provide an outline of the pathophysiological metabolic changes after major trauma that endorse the current basis for early immunonutrition of polytrauma patients

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries

Restrained eating in overweight children : does eating style run in families?

Overweight children show abnormalities in eating style, such as restrained eating and tendency toward overeating (comprising both emotional and external eating). Family surroundings play a major role in developing eating behaviors in children. We tested whether restrained eating and tendency toward overeating predicted the amount of food intake in 41 overweight children (23 girls and 18 boys) and their parents (40 mothers and 11 fathers) after receiving a preload. We further investigated with questionnaires whether there were associations between the parents' and their children's eating behavior and whether mothers' food intake predicted the amount of food consumed by children in an experimental trial. We found that neither children with restrained eating nor their mothers ate more after a preload, but children with a high tendency toward overeating ate somewhat more after receiving a preload. Further analyses showed that children's food intake in the preload paradigm was predicted by mothers' food intake. Our findings point to a familial transmission of eating styles: children eat as their primary caregivers do, even when the caregivers are not present in the laboratory

The CT 2-D reconstruction shows a thin fracture line in a completely but not dislocated fracture at C6/7

<p><b>Copyright information:</b></p><p>Taken from "Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis"</p><p>http://www.pssjournal.com/content/2/1/15</p><p>Patient Safety in Surgery 2008;2():15-15.</p><p>Published online 6 Jun 2008</p><p>PMCID:PMC2453107.</p><p></p

X-Ray's in standard plain show a reduced view of the lower cervical spine and of the cervico-thoracic junction

Furthermore, an accurate evaluation is difficult due to the ossification and osteoporosis.<p><b>Copyright information:</b></p><p>Taken from "Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis"</p><p>http://www.pssjournal.com/content/2/1/15</p><p>Patient Safety in Surgery 2008;2():15-15.</p><p>Published online 6 Jun 2008</p><p>PMCID:PMC2453107.</p><p></p

Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society

Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented. Five systematic reviews were conducted using multiple databases. The search retrieved articles regarding analgesia for blunt thoracic trauma from January1967 to August 2015. Critical outcomes of interest were analgesia, postoperative pulmonary complications, changes in pulmonary function tests, need for endotracheal intubation, and mortality. Important outcomes of interest examined included hospital and intensive care unit length of stay. Seventy articles were identified. Of these, 28 articles were selected to construct the guidelines. The overall risk of bias for all studies was high. The majority of included studies examined epidural analgesia. Epidural analgesia was associated with lower short-term pain scores in most studies, but the quality and quantity of evidence were very low, and no firm evidence of benefit or harm was found when this modality was compared with other analgesic interventions. The quality of evidence for paravertebral block, intrapleural analgesia, multimodal analgesia, and intercostal nerve blocks was very low as assessed by GRADE. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We propose two evidence-based recommendations regarding analgesia for patients with blunt thoracic trauma. The overall risk of bias for all studies was high. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We conditionally recommend epidural analgesia and multimodal analgesia as options for patients with blunt thoracic trauma, but the overall quality of evidence supporting these modalities is low in trauma patients. These recommendations are based on very low-quality evidence but place a high value on patient preferences for analgesia. These recommendations are in contradistinction to the previously published Practice Management Guideline published by EAST

Comparison study of two surgical options for distal tibia fracture—minimally invasive plate osteosynthesis vs. open reduction and internal fixation

The aim of this study was to compare the results between two surgical options for distal tibia fracture, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), and explore the benefits and defects of these two techniques. Thirty cases of distal tibia fracture (15 pairs of ORIF and MIPO) were submitted for pair comparison with consistence of gender, age and AO fracture classification. Indexes for evaluation included operative time, blood loss, healing time, time of recovery to work, implant irritation symptoms, and union status. Mazur grading standard was introduced for functional evaluation. Statistical Package for Social Sciences (SPSS) 13.0 was used for analysis. No malunion occurred and one case of osteomyelitis developed in the ORIF group. In the ORIF group, ten cases were evaluated as excellent, three as good, one as fair and one as poor. In the MIPO group, ten cases were excellent and five good. Paired t-test found no significant differences between groups on the indexes for analysis. In conclusion, the MIPO technique is not distinctively superior to ORIF in treatment of distal tibia fracture