8 research outputs found

    Outcome Following Peripheral Nerve Injury of the Forearm

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    Loss of hand function can be a frightening experience, the hand is an integral part of what makes us human. Nowhere else in the body is there such an amazing and complex functioning of bones, joints, muscles, tendons, nerves, blood vessels and skin as in the hand. The proper function and balance of all these elements is required for the hand to function to its full potential. The hands are the primary tool for interacting with our environment and, through touch, are also crucial for receiving information about our surroundings. About a quarter of the motor cortex in the human brain (the part of the brain which controls all movement in the body) is devoted to the muscles of the hands. This is usually illustrated with a drawing of a human figure draped over the side of the brain, body parts sized proportional to the amount of brain devoted to their movement, referred to as a homunculus - as illustrated in this drawing from Dr. Wilder Penfield’s monograph “The Cerebral Cortex of Man”. Until illness or injury forces people to focus on the importance of their hands, few people ever consider the consequences of being unable to use them. Any loss of hand function can have serious economic and psychological consequences. In fact, losing the use of your hand often means losing your job. Our hands are also part of our identity. Patients with severe upper extremity injuries can suffer psychologically from post-traumatic stress disorder. Unfortunately, we often fail to appreciate the function of the upper limb until it is injured, and that happens quite often

    Early posttraumatic psychological stress following peripheral nerve injury:A prospective study

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    <p>Background: Psychological symptoms frequently accompany severe injuries of the upper extremities and are described to influence functional outcome. As yet, little knowledge is available about the occurrence of posttraumatic psychological stress and the predictive characteristics of peripheral nerve injuries of the upper extremity for such psychological symptoms. In this prospective study, the incidence of different aspects of early posttraumatic stress in patients with peripheral nerve injury of the forearm is studied as well as the risk factors for the occurrence of early psychological stress.</p><p>Methods: In a prospective study design, patients with a median, ulnar or combined median-ulnar nerve injury were monitored for posttraumatic psychological stress symptoms with the Impact of Event Scale (IES) questionnaire up to 3 months postoperatively.</p><p>Results: Psychological stress within the first month after surgery occurred in 91.8% of the population (IES mean=22.0, standard deviation (SD)=17.3). Three months postoperatively, 83.3% (IES mean=13.3, SD=14.1) experienced psychological stress. One month postoperatively 24.6% and 3 months postoperatively 13.3% of the patients had IES scores indicating for the need for psychological treatment. Female gender, adult age and combined nerve injuries were related to the occurrence of psychological stress symptoms 1 month postoperatively.</p><p>Conclusions: In the majority of these patients, peripheral nerve injury of the forearm is accompanied by early posttraumatic psychological stress, especially in female adults who suffered from combined nerve injuries. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.</p>

    Differences in Mortality, Risk Factors, and Complications After Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysms

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    Objective/background: Endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) has faced resistance owing to the marginal evidence of benefit over open surgical repair (OSR). This study aims to determine the impact of treatment modality on early mortality after rAAA, and to assess differences in postoperative complications and long-term survival. Methods: Patients treated between January 2000 and June 2013 were identified. The primary endpoint was early mortality. Secondary endpoints were postoperative complications and long-term survival. Independent risk factors for early mortality were calculated using multivariate logistic regression. Survival estimates were obtained by means of Kaplan-Meier curves. Results: Two hundred and twenty-one patients were treated (age 72 +/- 8 years, 90% male), 83 (38%) by EVAR and 138 (62%) by OSR. There were no differences between groups at the time of admission. Early mortality was significantly lower for EVAR compared with OSR (odds ratio [OR]: 0.45, 95% confidence interval [Cl]: 0.21-0.97). Similarly, EVAR was associated with a threefold risk reduction in major complications (OR: 0.33, 95%Cl: 0.15-0.71). Hemoglobin level <11 mg/dL was predictive of early death for patients in both groups. Age greater than 75 years and the presence of shock were significant risk factors for early death after OSR, but not after EVAR. The early survival benefit of EVAR,over OSR persisted for up to 3 years. Conclusion: This study shows an early mortality benefit after EVAR, which persists over the mid-term. It also suggests different prognostic significance for preoperative variables according to the type of repair. Age and the presence of shock were risk factors for early death after OSR, while hemoglobin level on admission was a risk factor for both groups. This information may contribute to repair-specific risk prediction and improved patient selection. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved
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