TilE PRINCIPLES OF PHYSIOTIIERAPY OF TilE WAR WOUNDED WITII EXTERNAL FIXATOR

U Specijalnoj kliničkoj ortopedskoj bolnici Lovran liječeno je u periodu od kolovoza 1991. do veljače 1993. oko 600 ranjenika domovinskog rata. Izdvajamo grupu od 78 ranjenika kod kojih je u svrhu stabilizacije prijeloma, postavljen vanjski fiksator. Dio ranjenika je primljen u našu ustanovu sa već postavljenim vanjskim fiksatorom, kod nekih je fiksator promijenjen, a kod nekih prvi puta postavljen. Sa ranom rehabilitacijom počinje se kod svih ranjenika odmah po dolasku, a kod onih koji su operirani u našoj ustanovi 24 sata n3.kon operacije. Rehabilitaciloni postupak· počinje prvenstveno kineziterapijom i magnetnom terapijom. Kasnije se primjenjuju ostale fizikalno terapeutske procedure: terapija laserom, tens, interferentne struje, elektrostimulacija i ultrazvuk, te hidroterapijske procedure. · Rezultate smo ocjenili prema stupnju pokretljivosti koju smo postigli tijekom rehabilitacionog postupka. Dobar rezultat (pokretljivost zgloba od 70-100% od fiziološkog pokreta) postigli smo u 21,8% slučajeva, zadovoljavajući (pokretljivost između 40-70% fizioloških vrijednosti) u 48,7% i loši (pokretljivost od 0-40% od vrijednosti fiziološkog pokreta) u 29,5% ranjenika. Odvojeno smo promatrali grupu ranjenika kod kojih je u toku liječenja primjenjena magnetska terapija i zapazili bolje preživljavanje transplantata kože po Thiersch-u u usporedbi sa grupom gdje magnetska terapija nije provođena. Primjenom vanjskog fiksatora omogućena je rana aktivna rehabilitacija i brže izlječenje.In the Special orthopedic hospital Lovran in the period from August 1991 to February 1993 were cured six hunderd wounded in the war against Croatia. In the case of seventyeight of the wounded was applied a extemal fixator for the stabilisation of fractures. Some of wounded were accepted in our Clinic by an already applied external fixator, by some we have changed the apparatus. By some of them was it applied for the first time. By an early rehabilitation one begins by all of them immediately after their arrival, and at those who have been operated in our Clinic twentyfour hours after the operation the treatment begins by kinesiterapy and magnetotherapy. After that folows other physical therapeutic procedures, TENS, interpherent currency, electrostimulation, ultrasound and hydrotherapy. We have evaluated the results by the degree of mobility of joints. We have achieved good results (mobility 70-100% from psysio1ogycal mobility) in 21,8% of the cases, satisfying (mobility 40-70% physiologycal mobility) in 48,7%, unsatisfying (mobility 0-40% physiologycal mobility) 29,5%. Separately we have observed group of the wounded by whom we have applied magnetotherapy. We have noticed better survival of the skin transp1antation (Thiersch). External fixator makes possib1e active rehabilitation and a better curin

Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy

<p>Abstract</p> <p>Background</p> <p>To examine commonly used scoring systems, designed to predict overall outcome in critically ill patients, for their ability to select patients with an abdominal sepsis that have ongoing infection needing relaparotomy.</p> <p>Methods</p> <p>Data from a RCT comparing two surgical strategies was used. The study population consisted of 221 patients at risk for ongoing abdominal infection. The following scoring systems were evaluated with logistic regression analysis for their ability to select patients requiring a relaparotomy: APACHE-II score, SAPS-II, Mannheim Peritonitis Index (MPI), MODS, SOFA score, and the acute part of the APACHE-II score (APS).</p> <p>Results</p> <p>The proportion of patients requiring a relaparotomy was 32% (71/221). Only 2 scores had a discriminatory ability in identifying patients with ongoing infection needing relaparotomy above chance: the APS on day 1 (AUC 0.61; 95%CI 0.52-0.69) and the SOFA score on day 2 (AUC 0.60; 95%CI 0.52-0.69). However, to correctly identify 90% of all patients needing a relaparotomy would require such a low cut-off value that around 80% of all patients identified by these scoring systems would have negative findings at relaparotomy.</p> <p>Conclusions</p> <p>None of the widely-used scoring systems to predict overall outcome in critically ill patients are of clinical value for the identification of patients with ongoing infection needing relaparotomy. There is a need to develop more specific tools to assist physicians in their daily monitoring and selection of these patients after the initial emergency laparotomy.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN 51729393">ISRCTN 51729393</a></p

Association between trends in clinical variables and outcome in intensive care patients with faecal peritonitis: analysis of the GenOSept cohort

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

2013 WSES guidelines for management of intra-abdominal infections

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