ABSTRACT
BACKGROUND: The mortality rate in patients with haemodynamically unstable pelvic fractures is as high as 40-60%. In recent years, angioembolisation and pelvic packing have been introduced as part of a multimodality treatment for these patients. Protocol-driven management has been shown to improve outcomes. PATIENTS AND METHODS: This is a Level III retrospective cohort study of patients suffering from unstable pelvic fractures from 1 January 1996 to 30 September 2011. The aim of the study was to review our results, particularly in terms of mortality through the evolution of three phases of treatment protocols: preangiography, angiography and pelvic packing. RESULTS: The overall 30-day mortality rate for all patients was 47.2%, with a rate of 63.5% in the preangiography phase, 42.1% in the angiography phase and 30.6% in the pelvic packing phase. Multivariate logistic regression analysis identified the use of retroperitoneal packing as a significant independent predictive factor for 24 h mortality. CONCLUSIONS: Our results showed an improvement in patient survival with sequential protocols over the study period, during which we incorporated a multidisciplinary approach to managing these complicated pelvic fractures. The results strongly suggest that retroperitoneal packing should be highly recommended for bleeding subsequent to pelvic fracture, in addition to other modalities of treatment.
Subject(s)
Clinical Protocols/standards , Fractures, Bone/therapy , Hemorrhage/therapy , Pelvic Bones/injuries , Adult , Aged , Angiography/methods , Female , Fractures, Bone/diagnostic imaging , Fractures, Bone/mortality , Hemodynamics , Hemorrhage/diagnostic imaging , Hemorrhage/mortality , Hemostatic Techniques , Humans , Logistic Models , Male , Middle Aged , Pelvic Bones/diagnostic imaging , Retrospective Studies , Tampons, SurgicalABSTRACT
Vesicoureteric reflux is an important association of paediatric urinary tract infection. Fluoroscopic micturating cystourethrography and radionuclide cystography have been employed for detecting and grading vesicoureteric reflux. However, both modalities involve ionising radiation, which can pose significant radiation risk to growing children. They also have a lower detection rate due to intermittent fluoroscopic technique in micturating cystourethrography, and lower spatial resolution in radionuclide cystography. Therefore, newer radiation-free ultrasound-based contrast-enhanced voiding urosonography has been developed in Europe for 15 years. This article aimed to summarise the current literature and discuss the first local pilot study in our institution on detection of vesicoureteric reflux by contrast-enhanced voiding urosonography. Contrast-enhanced voiding urosonography is a valid alternative to micturating cystourethrography in assessing vesicoureteric reflux, based on its superior diagnostic performance, reliability, safety, feasibility, and radiation safety for children. Therefore, it should be incorporated in the guideline for investigating paediatric urinary tract infection.
Subject(s)
Urination , Vesico-Ureteral Reflux/diagnostic imaging , Child , Child, Preschool , Diagnostic Techniques, Urological , Female , Humans , Infant , Infant, Newborn , Male , Sensitivity and Specificity , UltrasonographyABSTRACT
OBJECTIVE: To examine the efficacy and safety of bronchial artery embolisation in patients with acute major haemoptysis and those with chronic recurrent haemoptysis. DESIGN: Retrospective review of clinical records. SETTING: Regional hospital, Hong Kong. PATIENTS: Clinical records of 70 consecutive patients who had undergone bronchial artery embolisation in Queen Elizabeth Hospital from 1998 to 2003 were reviewed. Altogether 74 bronchial artery embolisation procedures were attempted, 46 (62%) for acute major haemoptysis, and 28 (38%) for chronic recurrent bleeding. Follow-up data were available for 32 patients. MAIN OUTCOME MEASURES: After bronchial artery embolisation, the Kaplan-Meier method and log-rank tests were used to compare the probability of recurrence in the two patient categories. RESULTS: Overall immediate control was attained following 99% of the procedures, with a complication rate of 13%; all complications were mild and self-limiting. For the 32 patients (19 having acute major haemoptysis and 13 having chronic recurrent bleeding) with follow-up data available, the overall recurrence rate was 36% (26% in the acute and 47% in chronic group). No statistically significant difference in recurrence probability between the two groups was observed (P=0.24). Presence of active pulmonary tuberculosis was associated with increased risk of recurrence (P=0.005). CONCLUSION: Bronchial artery embolisation was noted to be effective and safe in both acute major and chronic recurrent haemoptysis.
