Endovascular treatment of an open cervical fracture with carotid artery tear

The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report

Neurostimulatory and ablative treatment options in major depressive disorder: a systematic review

Introduction Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general population and up to 20-25% for the lifetime period. Historical perspective Nowadays, conventional treatment includes psychotherapy and pharmacotherapy; however, more than 60% of the treated patients respond unsatisfactorily, and almost one fifth becomes refractory to these therapies at long-term follow-up. Nonpharmacological techniques Growing social incapacity and economic burdens make the medical community strive for better therapies, with fewer complications. Various nonpharmacological techniques like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, lesion surgery, and deep brain stimulation have been developed for this purpose. Discussion We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods. © The Author(s) 2010.Link_to_subscribed_fulltex

Revision of the CEAP classification for chronic venous disorders: Consensus statement

The CEAP classification for chronic venous disorders (CVD) was developed in 1994 by an international ad hoc committee of the American Venous Forum, endorsed by the Society for Vascular Surgery, and incorporated into "Reporting Standards in Venous Disease" in 1995. Today most published clinical papers on CVD use all or portions of CEAP. Rather than have it stand as a static classification system, an ad hoc committee of the American Venous Forum, working with an international liaison committee, has recommended a number of practical changes, detailed in this consensus report. These include refinement of several definitions used in describing CVD; refinement of the C classes of CEAP; addition of the descriptor n (no venous abnormality identified); elaboration of the date of classification and level of investigation; and as a simpler alternative to the full (advanced) CEAP classification, introduction of a basic CEAP version. It is important to stress that CEAP is a descriptive classification, whereas venous severity scoring and quality of life scores are instruments for longitudinal research to assess outcomes

Arterial injury in the lower limb from blunt trauma

BackgroundThe present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The ability of a scoring system to predict the outcome was tested.MethodsThere were 122 lower limb arterial injuries in 119 patients treated at the Royal Adelaide Hospital in the years 1962-1994. Prognostic factors considered were the site of the injury, the severity of the soft-tissue injury and shock, the presence of associated injuries and a description of the bone or joint injury. The mangled extremity severity score (MESS) was calculated retrospectively for each patient.ResultsThe outcome was primary amputation in 27 patients, delayed amputation in 36 patients and limb salvage in 59 patients. The seven deaths were all due to associated injuries. Factors associated with amputation were the severity of shock and soft-tissue injury (P ConclusionsThe major factor determining outcome was the severity of the soft-tissue injury. Progressive necrosis and infection was a major cause of late amputation. The MESS is not sufficiently precise to allow the decision regarding amputation to be made at the initial operation