Bowel injury following gynecological laparoscopic surgery

Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication.Methods: We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment.Results: Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed.Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatmen

An interactive problem-solving approach to teach traumatology for medical students

<p>Abstract</p> <p>Aim</p> <p>We aimed to evaluate an interactive problem-solving approach for teaching traumatology from perspectives of students and consider its implications on Faculty development.</p> <p>Methods</p> <p>A two hour problem-solving, interactive tutorial on traumatology was structured to cover main topics in trauma management. The tutorial was based on real cases covering specific topics and objectives. Seven tutorials (5-9 students in each) were given by the same tutor with the same format for fourth and fifth year medical students in Auckland and UAE Universities (n = 50). A 16 item questionnaire, on a 7 point Likert-type scale, focusing on educational tools, tutor-based skills, and student-centered skills were answered by the students followed by open ended comments.</p> <p>Results</p> <p>The tutorials were highly ranked by the students. The mean values of educational tools was the highest followed by tutor-centered skills and finally student-centered skills. There was a significant increase of the rating of studied attributes over time (F = 3.9, p = 0.004, ANOVA). Students' open ended comments were highly supportive of the interactive problem-solving approach for teaching traumatology.</p> <p>Conclusions</p> <p>The interactive problem-solving approach for tutorials can be an effective enjoyable alternative or supplement to traditional instruction for teaching traumatology to medical students. Training for this approach should be encouraged for Faculty development.</p

Distraction-related road traffic collisions

Objectives: We aimed to prospectively study distraction-related road traffic collision injuries, their contributory factors, severity, and outcome.Methods: Data were prospectively collected on all hospitalized road traffic collision trauma patients in Al-Ain City who were drivers at the collision time over one and half years. Driver’s inattentive behaviors preceding the collision were collected by interviewing the admitted drivers.Results: There were 444 drivers, 330 of them were fully oriented patients, out of them only 44 (13%) were distracted. Nineteen (5.8%) drivers were distracted by using mobile phones, 12 (3.6%) were pre-occupied with deep thinking, six (1.8%) were talking with other passengers, four (1.2%) were picking things in the vehicle, and three (0.9%) were using entertainment systems. The maximum distraction occurred during the time of 6 am - 12 noon when the traffic was crowded. There were no significant differences between distracted and non-distracted drivers in demographical and physiological factors, injured regions, and outcomes.Conclusion: Distraction of alert drivers causes 13% of road traffic collisions in Al-Ain city. About 40 percent of the distracted drivers involved in road traffic collisions (RTC) were using mobile phones. Our study supports the ban of use of cell phones while driving.Keywords: Distraction, prevention, road traffic collision, mobile phon

The biomechanics of lower limb injuries in frontal-impact road traffic collisions

Aim: We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions.Methods: In this narrative review, we identified articles through pubmed, Scopus and Science Direct search engines for the period of 1990-2014. Search terms included: “biomechanics”, “lower limb injury”, “hip injury”, “knee injury”, “foot and ankle injury” and “frontal impact collision”. We studied factors affecting the anatomical site, frequency and severity of the injuries.Results: The most common reported mechanisms of injury were: the impaction of the knee with the dashboard resulting in acetabular fracture or posterior hip dislocation; and toepan intrusion in combination with forceful application of the brake resulting in foot and ankle fractures. The probability of an occupant sustaining significant injury to the hip is increased in taller males, and being out of position during the collision. The probability of an occupant sustaining a fracture to the foot and ankle is increased in shorter female occupants with a large overlap impact or a near oblique collision.Conclusion: Understanding the biomechanics of frontal-impact road traffic collisions is useful in alerting clinicians to the potential lower limb injuries sustained in these collisions.Keywords: Biomechanics, frontal-impact collisions, lower limb injury, knee, thigh and hip injury, lower leg, foot and ankle injury

Surgeon-performed sonographic findings in a traumatic trans-anal rectal perforation

Early diagnosis and active management of trans-anal rectal injuries is essential for a favorable outcome. Intraperitoneal free air (IFA) is usually diagnosed by an erect Chest X-ray. Point-of-care ultrasound has been recently used to detect IFA. We report a 45-year-old male who presented to the Emergency Department with lower abdominal peritonitis. Surgeon-performed portable point-of-care ultrasound as an extension of the abdominal examination revealed an inflamed omentum with hypoechoic stranding, thickened non compressible small bowel, and free fluid in the pelvis. A transverse abdominal section of the right upper quadrant showed free intraperitoneal air. Rectal examination revealed a longitudinal rectal tear. Laparotomy has confirmed the sonographic findings. There was a 12 cm intraperitoneal tear of the anterior wall of the rectum which was necrotic. This case clearly demonstrates that portable point-of-care ultrasound gives very useful detailed information even when performed by a non radiologist. Surgeons should be encouraged to use point-of-care ultrasound after appropriate training

Seatbelts and road traffic collision injuries

Modification of seatbelts and their legislation played an important role in reducing morbidity and mortality of occupants in road traffic collisions. We aimed to review seatbelt development, its mechanism of action and its effects. Seatbelts reduce injury by preventing the occupant from hitting the interior parts of the vehicle or being ejected from the car. We have made a linear regression correlation between the overall seatbelt compliance and road traffic death rates in 46 high income countries to study the relationship between seatbelt use and mortality. There was a very highly significant negative correlation between the seatbelt compliance and road traffic death rates (R = - 0.77, F = 65.5, p < 0.00001). Seatbelt-related injuries include spinal, abdominal or pelvic injuries. The presence of a seatbelt sign must raise the suspicion of an intra-abdominal injury. These injuries can be reduced if seatbelts were applied correctly. Although seatbelts were recognized as an important safety measure, it still remains underused in many countries. Enforcement of seatbelt usage by law is mandatory so as to reduce the toll of death of road traffic collisions

Lower limb and associated injuries in frontal-impact road traffic collisions

Objectives: To study the relationship between severity of injury of the lower limb and severity of injury of the head, thoracic, and abdominal regions in frontal-impact road traffic collisions.Methods: Consecutive hospitalised trauma patients who were involved in a frontal road traffic collision were prospectively studied over 18 months. Patients with at least one Abbreviated Injury Scale (AIS) ≥3 or AIS 2 injuries within two AIS body regions were included. Patients were divided into two groups depending on the severity of injury to the head, chest or abdomen. Low severity group had an AIS &lt; 2 and high severity group had an AIS ≥ 2. Backward likelihood logistic regression models were used to define significant factors affecting the severity of head, chest or abdominal injuries.Results: Eighty-five patients were studied. The backward likelihood logistic regression model defining independent factors affecting severity of head injuries was highly significant (p =0.01, nagelkerke r square = 0.1) severity of lower limb injuries was the only significant factor (p=0.013) having a negative correlation with head injury (Odds ratio of 0.64 (95% CI: 0.45-0.91).Conclusion: Occupants who sustain a greater severity of injury to the lower limb in a frontal-impact collision are likely to be spared from a greater severity of head injury.Keywords: Frontal-impact, road traffic collision, lower limb injur

The biomechanics of lower limb injuries in frontal-impact road traffic collisions

Aim: We aimed to review the biomechanics of lower limb injuries caused by frontal-impact road traffic collisions. Methods: In this narrative review, we identified articles through pubmed, Scopus and Science Direct search engines for the period of 1990-2014. Search terms included: \u201cbiomechanics\u201d, \u201clower limb injury\u201d, \u201chip injury\u201d, \u201cknee injury\u201d, \u201cfoot and ankle injury\u201d and \u201cfrontal impact collision\u201d. We studied factors affecting the anatomical site, frequency and severity of the injuries. Results: The most common reported mechanisms of injury were: the impaction of the knee with the dashboard resulting in acetabular fracture or posterior hip dislocation; and toepan intrusion in combination with forceful application of the brake resulting in foot and ankle fractures. The probability of an occupant sustaining significant injury to the hip is increased in taller males, and being out of position during the collision. The probability of an occupant sustaining a fracture to the foot and ankle is increased in shorter female occupants with a large overlap impact or a near oblique collision. Conclusion: Understanding the biomechanics of frontal-impact road traffic collisions is useful in alerting clinicians to the potential lower limb injuries sustained in these collisions