The prognostic significance of thoracic and abdominal trauma in severe trauma patients (Injury severity score > 15).

The aim of the present study was to assess the prognostic significance of thoracic and abdominal trauma in severely injured patients. A retrospective analysis was performed based on data from the period from March 1 2006 to December 31 2007, taken from the Trauma Registry of the University Hospital "SantAndrea" in Rome. A total of 844 trauma patients were entered in a database created for this purpose, and only patients with an Injury Severity Score (ISS) > 15, (163 patients, 19.3%), were selected for the present study. These patients were divided into 2 groups: Group A (103 patients, 63.2%), consisting of patients with at least one thoracic injury, and Group B (46 patients, 28.2%) consisting of patients with concomitant thoracic and abdominal injuries. The impact of thoracic and abdominal trauma was studied by analyzing mortality and morbidity, in relation to patient age, cause and dynamics of trauma, length of hospital stay, and both ISS and New ISS (NISS). In a vast majority of cases, the cause of trauma was a road accident (126 patients, 77.3%). The mean age of patients with ISS > 15 was 45.2 +/- 19.3 years. The mean ISS and NISS were 25.7 +/- 10.5 and of 31.4 +/- 13.1 respectively. The overall morbidity and mortality rates were 18.4% (30 patients) and 28.8% (47 patients) respectively. In Group A the mortality rate was 23.3% (24 patients) and the morbidity rate was 33.9% (35 patients). In Group B mortality and morbidity rates were 369% (17 patients) and 43.5% (20 patients) respectively. It was shown that the presence of both thoracic and abdominal injuries significantly increases the risk of mortality and morbidity. In patients with predominantly thoracic injuries, NISS proved to be the more reliable score, while ISS appeared to be more accurate in evaluating patients with injuries affecting more than one region of the body.

The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry.

Abdominal trauma is present in 7-10% of all trauma victims, and in cases of severe trauma is often found together with orthopedic, thoracic or central nervous system (CNS) injuries. The aim of the present study was to perform a comparative analysis of abdominal trauma and trauma involving other body regions, evaluating the prognostic significance of abdominal injuries in patients with severe trauma, based on data from a multidisciplinary trauma registry. Data from the period from March 1 2006 to December 31 2007 was collected from the trauma registry of the University Hospital Sant'Andrea in Rome, Italy. There were 25.875 patients (31.4%) with the diagnosis of trauma out of a total of 82.293 patients admitted to the emergency department. Eight hundred forty-four patients were selected according to specific inclusion criteria and patients with abdominal injuries were further selected. The following data were investigated: patient age, the trauma mechanism, duration of recovery, Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), type and the incidence of abdominal and extra-abdominal injuries. Morbidity and mortality, especially in patients with spleen and liver injuries, were analyzed. There were 79 patients (9.3%) with abdominal trauma. Their mean ISS was 25.7 +/- 14.3. Sixty-one (77.2%) of these patients had sustained severe trauma (ISS > 15). Forty-one patients (51.8%) underwent surgery. The overall mortality rate was 24.1%, 19 patients all with ISS > 15, so that the mortality rate for patients with severe trauma was 31.2%. Splenic trauma was the most frequent, and was found in 36 patients (45.6%) whose mean ISS was 31.1 +/- 144. Twenty-two patients (61.6%) were treated surgically; a total of 21 splenectomies and one laparoscopic procedure to control bleeding were performed. Overall mortality among patients with splenic trauma was 30.5% (11 patients), with an average spleen AIS of 3.3 +/- 0.8 (died vs. survived p = n.s.). Liver injuries were found in 33 patients (41.7%). The mean ISS was 28.4 +/- 11.6. Sixty-five percent of the patients were given nonsurgical treatment. Overall mortality among liver trauma patients was 24.2% (8 patients) with an average liver AIS of 3.2 +/- 0.3 (died vs. survived p < 0.05). In multivariate analysis, among the general population of trauma patients, the ISS (p < 0.001), patient age (p < 0.003), and an orthopedic (p < 0.002) or CNS injury (p < 0.006) proved to be significant independent predictors of the presence of an abdominal injury. Multivariate analysis showed that in patients with abdominal trauma, only the ISS (p < 0.001) was a significant independent predictor of mortality.

[Emergency colonic surgery: analysis of risk factors predicting morbidity and mortality]. / Chirurgia del colon in urgenza: analisi dei fattori di rischio di morbilità e mortalità.

The aim of the present study was to identify risk factors for morbidity and mortality in patients submitted to emergency colonic surgery. Between 1997 and 2008 157 patients, 106 of whom affected by colon cancer (67.5%) and 51 by benign disease (32.5%), were treated. The risk factors for morbidity and mortality were evaluated by univariate and multivariate analysis considering clinical and demographic data. The overall 30-day morbidity and mortality rates were 19.1% (30 patients) and 12.7% (20 patients), respectively. Among patients affected by cancer the mortality rate was 15% (16 patients) and the morbidity rate 23.6% (25 patients), while among the patients with benign disease the mortality rate was 7.8% (4 patients) and the morbidity rate 9.8% (5 patients). No postoperative surgical complications were noted. The strongest risk factors for early death were postoperative medical complications such as cardiopulmonary, renal, thrombo-embolic and infectious complications. The results of the univariate analysis showed that advanced age, neoplastic disease, advanced stage of cancer and associated medical disease prior to surgery play a role as risk factors for morbidity and mortality. In the multivariate analysis only the presence of associated medical disease proved to be a significant independent predictor of outcome. Emergency surgery for both neoplastic and benign colonic disease is still associated with an increased risk of death. Although restorative colectomy should be regarded as the first choice procedure in the emergency setting, Hartmann's procedure is still widely used in high-risk patients.

[Thyreopathy associated with vagus schwannoma]. / Tireopatia associata a schwannoma del vago.

We report the case of a young woman who underwent total thyroidectomy for a suspect nodular thyreopathy and occasionally happened to be affected simultaneously by vagus nerve schwannoma. Symptomatology is discussed and we propose a review of the literature about this non frequent pathology and discuss the latest diagnostic procedures and surgical indications and treatment.

The management of retrorectal congenital tumors.

Although retrorectal congenital tumors are still rare, the number of the observed ones is destined to increase, as methods by imaging become routinely used in the clinical practice. By presenting three clinical cases the authors describe the surgical technique of the anterior route they performed for the management of such formations. The abdominal approach had no postoperative complications, short hospital stay, no neurological consequences and good long-term results. There has been no evidence of recurrence thus far. Once diagnosed, the removal of retrorectal lesions should be mandatory. A precise definition of the extent of the tumors and of their relationships with the surrounding tissue and organs is necessary to perform maneuvers of total excision. For this reason an abdominal approach is recommended.