Estudo epidemiológico das queimaduras no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro / Epidemiological study of burns at the Hospital of Clinics, Federal University of the Triângulo Mineiro

Introdução: As queimaduras são um grave problema de saúde pública. O conhecimento dos principais dados epidemiológicos dos pacientes acometidos é de suma importância para a prevenção e instituição do melhor tratamento clínico a esses indivíduos. Objetivou-se realizar um levantamento sobre o perfil epidemiológico das queimaduras, os principais mecanismos envolvidos, tratamentos e desfechos destes casos no Hospital de Clínicas da UFTM. Métodos: Trata-se de um estudo retrospectivo e transversal, das internações por queimadura no HC- UFTM, de janeiro de 2015 a dezembro de 2019. Foram avaliados: gênero, idade, profundidade das queimaduras, localização, etiologia, utilização de opioides, tempo de internação hospitalar, desfecho (alta hospitalar ou óbito) e extensão das áreas queimadas (SCQ%). Resultados: Este estudo foi composto por 138 pacientes, divididos em 3 grupos: grupo 1 (G1), 39 pacientes; o grupo 2 (G2), 89 participantes, dos quais 5 foram a óbito; e o grupo 3 (G3), 10 participantes, sendo que 4 vieram a óbito. Quanto ao mecanismo do trauma, o mais comum foi por escaldadura (17,39%), seguida pela queimadura térmica (13,76%), pelo álcool (8,69%) e queimaduras elétricas (5,79%). Conclusão: Houve uma maior prevalência de queimaduras de segundo grau em pacientes do gênero masculino. O mecanismo de trauma mais prevalente foi escaldadura e a SQC teve média de 23,9%. A face e o pescoço foram os segmentos mais acometidos e 61,59% dos pacientes necessitaram com uso de opioides na internação. Com relação ao desfecho, 91,30% dos pacientes receberam alta hospitalar e 6,52% vieram a óbito, com a maioria dos casos no G2.

Introduction: Burns are a serious public health problem. Knowledge of the main epidemiological data of affected patients is paramount for preventing and establishing the best clinical treatment for these individuals. The objective was to survey the epidemiological profile of burns, the main mechanisms involved, treatments, and outcomes of these cases at the Hospital de Clínicas da UFTM. Methods: This is a retrospective and cross-sectional study of hospitalizations for burns at HC-UFTM from January 2015 to December 2019. Gender, age, depth of burns, location, etiology, use of opioids, hospitalization duration, outcome (hospital discharge or death), and extent of burned areas (EBA%). Results: This study was composed of 138 patients, divided into three groups: group 1 (G1), 39 patients; group 2 (G2), 89 participants, of which 5 died; and group 3 (G3), 10 participants, 4 of whom died. As for the trauma mechanism, the most common was scald (17.39%), followed by thermal burn (13.76%), alcohol (8.69%), and electric burns (5.79%). Conclusion: There was a higher prevalence of second-degree burns in male patients. The most prevalent mechanism of trauma was scald, and the EBA had an average of 23.9%. The face and neck were the most affected segments, and 61.59% of the patients required opioids during hospitalization. Regarding the outcome, 91.30% of patients were discharged from the hospital, and 6.52% died, with most cases in G2.

Correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma / 中华创伤杂志

Objective To investigate the correlation between acute gastrointestinal injury severity and intestinal microenvironment in rabbits with severe multiple trauma.Methods A total of 60 New Zealand white rabbits were enrolled and randomly assigned into the experimental group (48 rabbits) and control group (12 rabbits).In experimental group,the models of traffic-induced injuries were successful made by using self-made small gravity traction colliders.There were nine rabbits with craniocerebral injury combined with damage of liver and spleen,three with four extremity fractures combined with damage of liver and spleen,12 with rib fractures combined with damage of lungs and pleural effusion,11 with epidural hematoma,contusion and laceration of brain as well as fractures of four extremities and pelvis,and nine with multiple fractures.The injuries had met the criteria of multiple severe traumas according to the injury severity score (ISS).The control group had similar condition with experimental group except for participation in injury model.The parameters at time points of 6,12,24 and 48 h after injury were observed.The parameters were:(1)Enzyme linked immunosorbent assay (ELISA) and high pressure liquid chromatography (HPLC) were used to detect the levels of diamine oxidase (DAO) and the ratio of lactulose to mannitol in urine in order to evaluate the permeability of intestinal mucosal barrier.(2) The small intestinal propulsive rate was detected by carbon pushing mcthod.The interstitial cells of Cajal in the snall intestine wall were observed by transmission electron microscopy.The expression of C-kit was detected by Western blot.By these means,the dynamic function of intestinal mucosal barrier was evaluated.(3) The damage degree of intestinal nucosal barrier was evaluated by pathological observation and Chiu score in the end of small intestine and colon.(4)The intestinal bacterial translocation was evaluated by intestinal microflora culture,mesenteric lymph nodes checking as well as translocation examination of liver and spleen.Results (1) The level of DAO plasma and urine lactulose/mannitol ratio at 6 h after injury increased to varied degrees,and reached the peak during 12-24 h,the correlation analysis of which showed that plasma DAO levels were positively correlated with AGI grade at 6,12 and 24 h (r =0.486 3,0.493 3,0.477 6,P ＜ 0.05).The ratio of urinary lactulose/ mannitol excretion was only positively correlated with AGI grade at 6 and 12 h (r =0.478 5,0.497 2,P ＜ 0.05).(2) The gastrointestinal transmission rate in the experimental group was (48.2 ± 5.2) ％,and that of the control group was (60.3 ± 3.0) ％.The gastrointestinal transmission rate of model group rabbits was significantly longer than that of control group (P ＜ 0.05).(3) The interstitial cells of Cajal decreased dramatically during 12-24 h after the injury,and the expression level of C-kit protein decreased consistently with the increase of AGI grade.(4) The intestinal and colonic mucosa tissues of the experimental group showed obvious necrosis at 12-24 h after injury,and the Chiu score increased gradually with the increase of AGI grade under light microscope.(5) The Enterobacter and Enterococcus in the experimental group increased significantly compared with that in the control group.But the numbers of Bifidobacterium,Lactobacillus,Lactobacillus,Bacteroides as well as the ratio of Bifidobacterium to Enterobacteriaceae significantly decreased(P ＜0.05).(6)The organ bacterial translocation rates were 24％,42％ and 62％ after injury in experimental group (P ＜0.05).Conclusions Acute gastrointestinal injury may occur early after severe multiple trauma,and the injury severity is closely related to the change of intestinal barrier function and bacterial translocation.Early attention and active correction of the change of intestinal microenvironment are of great importance for treatment of multiple trauma.

Pattern of Maxillofacial Fractures in Severe Multiple Trauma Patients: A 7-year Prospective Study

The incidence of facial trauma is high. This study has the primary objective of documenting and cataloging maxillofacial fractures in polytrauma patients. From a total of 1229 multiple trauma cases treated at the Emergency Room of the Santo Antonio Hospital - Oporto Hospital Center, Portugal, between August 2001 and December 2007, 251 patients had facial wounds and 209 had maxillofacial fractures. Aged ranged form 13 to 86 years. The applied selective method was based on the presence of facial wound with Abbreviated Injury Scale ≥1. Men had a higher incidence of maxillofacial fractures among multiple trauma patients (86.6%) and road traffic accidents were the primary cause of injuries (69.38%). Nasoorbitoethmoid complex was the most affected region (67.46%) followed by the maxilla (57.42%). The pattern and presentation of maxillofacial fractures had been studied in many parts of the world with varying results. Severe multiple trauma patients had different patterns of maxillofacial injuries. The number of maxillofacial trauma is on the rise worldwide as well as the incidence of associated sequelae. Maxillofacial fractures on multiple trauma patients were more frequent among males and in road traffic crashes. Knowing such data is elementary. The society should have a key role in the awareness of individuals and in prevention of road traffic accidents.

É alta a incidência de traumas na face. Este estudo teve por objetivo documentar e catalogar as fraturas maxilofaciais em pacientes com politraumatismos. De um total de 1229 casos de politraumatizados tratados na Sala de Emergência do Hospital de Santo António - Centro Hospitalar do Porto, Portugal, entre Agosto de 2001 e Dezembro de 2007, 251 pacientes tiveram ferimentos na face e 209 apresentaram fraturas maxilofaciais. As idades variaram de 13 a 86 anos. O método de seleção baseou-se na presença de ferimentos na face com Abreviated Injury Scale ≥1. Os homens apresentaram maior incidência de fraturas maxilofaciais (86,6%) entre os pacientes com múltiplos traumatismos na face e os acidentes de trânsito foram a causa principal dos traumatismos (69,38%). A região mais afetada foi o complexo naso-órbito-etmoidal (67,46%), seguido pela maxila (57,42%). O padrão e a apresentação das fraturas maxilofaciais tem sido estudado em muitas regiões do mundo com resultados variados. Pacientes com politraumatizados graves apresentaram padrões diferentes de traumatismos maxilofaciais. O número de traumatismos maxilofaciais tem aumentado à escala mundial, assim como a incidência das sequelas associadas. Entre os pacientes com traumatismos múltiplos, a maioria pertencia ao sexo masculino, assim como a causa mais frequente foram os acidentes automobilísticos. É elementar o conhecimento destes dados. A sociedade tem um papel primordial nos cuidados individuais e na prevenção dos acidentes de trânsito.

Debranched Thoracic Endovascular Aortic Aneurysm Repair in a Case of Blunt Aortic Injury / 日本心臓血管外科学会雑誌

A 16-year-old boy had a motorcycle accident and was given a diagnosis of blunt aortic injury (BAI) by contrast computed tomography (CT), complicated by diffuse brain injury, lung contusions and blunt liver injury. Despite conservative treatment his anemia worsened and further CT images revealed mediastinal hematoma. It was difficult to perform cardiopulmonary bypass with systemic heparinization because of his multiple injuries and therefore decided to perform endovascular stentgrafting. Aortography revealed that the proximal stent-graft landing zone to be very small, and therefore it was necessary to the cover left common carotid artery. Before stentgrafting, we performed a right subclavian artery-left common carotid artery bypass to attain a sufficient proximal landing zone, and stentgrafting was successful. We concluded that endovascular stentgrafting is an effective initial treatment for BAI complicated with multiple injuries. However, endovascular stentgrafting for BAI has some limitations because of the morphologic and anatomical characteristics of the thoracic aorta in cases of BAI. It is therefore important to perform endovascular stentgrafting for BAI on a case-by-case basis.

Analysis of prognostic factors of 324 patients with multiple traumas / 中华急诊医学杂志

Objective To explore the effective prognostic factors of patients with multiple traumas. Method During January 2003 to March 2007, totally 324 patients with multiple traumas were treated in the emergency department of Renmin Hospital, Wuhan University. The relationship between prognosis and age, visiting time after injury, injury severity score (ISS) ,main wounded part and shock degree was analyzed. The data were tested using ehi-square test and logistic regression method. Results Seventy-eight patients died and 246 patients survived, the total mortality was 24.1%. Statistical differences existed in mortalities of patients with different visiting time (visiting hospital within 1 h,16.7%; visiting hospital beyond 1h, 37.4%),ISS (16≤ISS≤24, 5.7%; 25≤ISS≤40, 19.2%; IS8>40, 41.3%) and shock degree (non-shock, 11.8%; mild shock, 13.6%; moderate shock,27.7%; severe shock,46.9% ) ( P<0.01). There were no significant difference in mortalities among patients with different age (<18, 23.8% ; 18～38, 21.7% ; 38～58, 24.2% ;>58, 32.5% ) and with various main wounded part (head, 26.0%; neck, 25.3%; chest, 27.3%; abdomen, 24.1%; limbs, spine and pelvis,16.3%), P>0.05. Logistic regression study showed that mortality increased with postponed visiting time after injury, augment of ISS and aggravation of shock degree, with the exception that there was no differenoe in mortality of patients with between non-shock and mild shock. Conclusions Visiting time after injury, ISS and shock degree were valuable progrostic predictors for multiple traumas. It's vital to follow principle of damage controlled surgery and emphasis on the timeliness and integrity of medical rescue and control shock actively to reduce mortality of patients with multiple injuries.

Assessing the emergency situation for peripheral vascular wounds/trauma in Viet Duc Hospital from 2004 to 2006

Background: peripheral vascular wounds/trauma is a severe type of surgical emergency, the increasing rate due to the rapid increase of traffic, labor and living accidents. Subjectives and Method: retrospective study, all patients with peripheral vascular wounds/traumas (alone or combination in multiple trauma) were emergency operated at Viet Duc Hospital from January 2004 to June 2006. Results: A total of 310 patients with peripheral vascular injuries in the study, of which accounted for 62.3% of injury, trauma group accounted for 37.7%. The mean age of 30. In first aid, pressed tape accounted for high rate (71.5%). Rate of popliteal vascular trauma due to fractures around the knee accounted for 65.5%, the rate of brachial vascular trauma with fractures around the elbow was 50%. Rate of late diagnosis of arterial trauma was 14.6%, higher than the arterial wounds (2.6%). The rate of ultrasound for forelimbs - where vessels were many wounds, was lower than that for hindlimbs - where vessels were many traumas (44% vs 67.9%). For vascular wounds, more directly vascular connection and more intervention on veins, whereas, for arterial trauma, more vascular graft. Rate of complications was low (7.4%), with no deaths. Conclusions: Overall, the results of emergency surgery for peripheral vascular wounds/trauma were well. No cases was death from vascular lesions, rate of complications was low.

The Prognostic Factors in Multiple Traumas in Children

PURPOSE: Trauma is the leading cause of death among children age 1 to 15 years. The initial assessment of injured children is also important for the adequate treatment and transfer of these patients when required. A number of trauma scoring systems have been applied to the pediatric trauma population, with the Pediatric Trauma Score (PTS) being specifically developed as a triage tool for specifically for children. The ability of the PTS to predict the severity of an injury and mortality, and the value of the PTS were evaluated. METHODS: Seventy patients younger than 16 years of age, with multiple organ injuries, were assessed for 5 years, from January 1, 1997 to December 31, 2001. The demographic and clinical variables were retrospectively analyzed and the PTS assessed. RESULTS: Motor vehicle related injuries caused the majority of the multiple organ injuries the children, with liver injuries accounting for the greatest numbers. The survivals showed differences in relation to age, sex, number of injured organs and PTS, but no statistical significance was proved from a univariate analysis. From the multivariated analysis, only the PTS showed statistical significance. There were 5 deaths where the PTS was more than 9 points, was accounting for 55% of all mortalities. CONCLUSION: The PTS is an important triage for injured children, but could not reflect the prognosis of the injured patients when the clinical appearances were not reflected.