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15 pages, 1521 KiB  
Review
The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients
by Samuel J. Thomas, Vraj S. Patel, Connor P. Schmitt, Aleksey T. Zielinski, Mia N. Aboukhaled, Christopher A. Steinberg, Ernest E. Moore, Hunter B. Moore, Scott G. Thomas, Dan A. Waxman, Joseph B. Miller, Connor M. Bunch, Michael W. Aboukhaled, Emmanuel J. Thomas, Saniya K. Zackariya, Halina Oryakhail, Alexander Mehreteab, Reagan E. Ludwig, Sarah M. George, Aayan I. Siddiqi, Bilal M. Zackariya, Aadil Qasim, Mark M. Walsh and Mahmoud D. Al-Fadhladd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(15), 5426; https://doi.org/10.3390/jcm14155426 - 1 Aug 2025
Viewed by 254
Abstract
In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further [...] Read more.
In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further exacerbating current blood product shortages. Previous studies have used various transfusion cut-points per hour to define futility in retrospective analyses but have not accurately defined futility at the bedside due to patient survival even at large rates and volumes of blood transfused. In an attempt to use transfusion cut-points as a marker to help define futility, guidelines have been proposed to limit blood product waste in transfusions for severely bleeding trauma patients, such as Suspension of Transfusion and Other Procedures (STOP) for patients older than 15 and the Futility of Resuscitation Measure (FoRM), used to determine futility in patients older than 60. In an effort to construct effective bedside futile resuscitation criteria with 100% positive predictive value and specificity, this review proposes the use of specific blood component transfusion cut-points combined with parameters from both STOP and FoRM to allow for a comprehensive and accurate method of declaring futility in severely bleeding trauma patients. Full article
(This article belongs to the Special Issue Current Trends and Prospects of Critical Emergency Medicine)
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13 pages, 617 KiB  
Article
Management and Outcomes of Blunt Renal Trauma: A Retrospective Analysis from a High-Volume Urban Emergency Department
by Bruno Cirillo, Giulia Duranti, Roberto Cirocchi, Francesca Comotti, Martina Zambon, Paolo Sapienza, Matteo Matteucci, Andrea Mingoli, Sara Giovampietro and Gioia Brachini
J. Clin. Med. 2025, 14(15), 5288; https://doi.org/10.3390/jcm14155288 - 26 Jul 2025
Viewed by 303
Abstract
Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are [...] Read more.
Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III–V), beyond its established role in low-grade injuries (grades I–II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I–II) accounted for 43% (n = 105), while high-grade injuries (AAST III–V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes. Full article
(This article belongs to the Special Issue Emergency Surgery: Clinical Updates and New Perspectives)
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8 pages, 696 KiB  
Case Report
A Rare Case Report of Wunderlich Syndrome in a Chronic Hemodialysis Patient
by Elizabeth Artinyan, Evelina Valcheva, Marina Vaysilova and Nikolay Dimov
Reports 2025, 8(3), 121; https://doi.org/10.3390/reports8030121 - 25 Jul 2025
Viewed by 306
Abstract
Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich syndrome (WS), is a rare disease characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces without a history of prior trauma. WS can be a [...] Read more.
Background and Clinical Significance: Spontaneous renal hematoma, also known as Wunderlich syndrome (WS), is a rare disease characterized by the acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces without a history of prior trauma. WS can be a life-threatening condition due to hemorrhagic shock; consequently, prompt diagnosis and a therapeutic approach are essential for favorable outcomes. Treatment ranges from conservative management to surgical intervention. The most common etiologies are neoplasms and vascular diseases, but WS can also be observed in patients undergoing hemodialysis. In patients with end-stage renal disease (ESRD), especially those on hemodialysis, acquired cystic kidney disease and renal cell carcinoma are among the primary causes of WS. Although less common, WS can develop in dialysis patients even in the absence of traditional (primary) risk factors. In general, patients with chronic kidney disease (CKD) have a paradoxical hemostatic profile, likely explaining their higher tendency to bleed, so WS can occur without existing predisposing factors. The multifactorial pathogenesis in these patients includes functional platelet abnormalities, intimal arterial fibrosis, chronic inflammation, and oxidative stress associated with ESRD. The use of hemodialysis-related antithrombotic medications could serve as another contributing factor increasing the risk of bleeding. Case Presentation: We present a case report of a 62-year-old male on chronic dialysis who developed sudden right-sided lumbar pain and hematuria during dialysis without evidence of prior trauma. Imaging revealed a large subcapsular hematoma of the right kidney. Further investigations did not reveal additional risk factors in this instance; however, his routinely used hemodialysis-related antithrombotic medications were potentially a contributing factor. Despite conservative treatment, his condition worsened, and the hematoma enlarged, requiring emergency nephrectomy. Postoperatively, his condition gradually improved. Conclusions: This case highlights the importance of considering WS in hemodialysis patients, even without the presence of traditional risk factors, as well as including WS in the differential diagnosis of acute abdominal pain. Full article
(This article belongs to the Section Nephrology/Urology)
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10 pages, 609 KiB  
Article
Performance of the InfraScanner for the Detection of Intracranial Bleeding in a Population of Traumatic Brain Injury Patients in Colombia
by Santiago Cardona-Collazos, Sandra Olaya-Perea, Laura Fernández, Dylan Griswold, Alvaro Villota, Sarita Aristizabal, Elizabeth Ginalis, Diana Sanchez, Angelos Kolias, Peter Hutchinson and Andres M. Rubiano
Emerg. Care Med. 2025, 2(3), 35; https://doi.org/10.3390/ecm2030035 - 23 Jul 2025
Viewed by 205
Abstract
Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in [...] Read more.
Background/Objectives: Traumatic brain injury (TBI) is a global public health concern, affecting over 60 million people annually. It is associated with high rates of mortality and disability, particularly among young and economically active individuals, and remains the leading cause of death in people under 40 years of age. Although computed tomography (CT) is the standard method for excluding intracranial bleeding (ICB), it is frequently unavailable in resource-limited settings where the burden of TBI is greatest. The InfraScanner 2000 is a near-infrared spectroscopy (NIRS) device designed to detect ICB and may serve as a triage tool in environments without access to CT imaging. This study aimed to evaluate the diagnostic performance of the InfraScanner 2000 for detecting ICB in the emergency department (ED) of a trauma center in a cohort of Colombian patients with TBI. Methods: This prospective study was conducted in Cali, Colombia, between December 2019 and February 2021. Adult patients presenting to the ED with blunt TBI were enrolled. InfraScanner assessments were performed according to a standardized protocol, and all participants underwent head CT within 6 h of injury. Results: A total of 140 patients were included. Of these, 66% were male and 34% were female. Most patients (63.57%) were between 18 and 39 years old, with a median age of 39 years (IQR: 18–86). The InfraScanner demonstrated a sensitivity of 60.0% (95% CI: 32.5–84.8), specificity of 78.4% (95% CI: 71.2–85.6), positive predictive value (PPV) of 25.0%, and negative predictive value (NPV) of 94.2% for detecting ICB. Conclusions: The InfraScanner 2000 showed good specificity and high NPV in identifying ICB among Colombian patients with TBI. These findings suggest it could serve as a useful triage tool to support decision-making in emergency settings with limited access to CT imaging. Full article
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12 pages, 3688 KiB  
Article
Automated Traumatic Bleeding Detection in Whole-Body CT Using 3D Object Detection Model
by Rizki Nurfauzi, Ayaka Baba, Taka-aki Nakada, Toshiya Nakaguchi and Yukihiro Nomura
Appl. Sci. 2025, 15(15), 8123; https://doi.org/10.3390/app15158123 - 22 Jul 2025
Viewed by 282
Abstract
Traumatic injury remains a major cause of death worldwide, with bleeding being one of its most critical and life-threatening consequences. Whole-body computed tomography (WBCT) has become a standard diagnostic method in trauma settings; however, timely interpretation remains challenging for acute care physicians. In [...] Read more.
Traumatic injury remains a major cause of death worldwide, with bleeding being one of its most critical and life-threatening consequences. Whole-body computed tomography (WBCT) has become a standard diagnostic method in trauma settings; however, timely interpretation remains challenging for acute care physicians. In this study, we propose a new automated method for detecting traumatic bleeding in CT images using a three-dimensional object detection model enhanced with an atrous spatial pyramid pooling (ASPP) module. Furthermore, we incorporate a false positive (FP) reduction approach based on multi-organ segmentation, as developed in our previous study. The proposed method was evaluated on a multi-institutional dataset of delayed-phase contrast-enhanced CT images using a six-fold cross-validation approach. It achieved a maximum sensitivity of 90.0% with 587.3 FPs per case and a sensitivity of 70.0% with 46.9 FPs per case, outperforming previous segmentation-based methods. In addition, the average processing time was reduced to 4.2 ± 1.1 min. These results suggest that the proposed method enables rapid and accurate bleeding detection, demonstrating its potential for clinical application in emergency trauma care. Full article
(This article belongs to the Special Issue Research Progress in Medical Image Analysis)
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10 pages, 2128 KiB  
Article
Extremity and Mandibular Reconstruction After Gunshot Trauma—Orthoplastic Strategies from Five Years of Humanitarian Missions in a Resource-Limited Setting
by Viktoria Koenig, Tomas Kempny, Jakub Holoubek, Tomas Votruba and Julian Joestl
J. Clin. Med. 2025, 14(14), 4852; https://doi.org/10.3390/jcm14144852 - 8 Jul 2025
Viewed by 320
Abstract
Background: Surgical care in conflict regions like Tigray, Ethiopia, faces severe challenges due to limited resources, infrastructural deficiencies, and high trauma burden. From 2019 to 2023, a multidisciplinary team conducted five humanitarian missions focusing on orthoplastic reconstruction of extremity and mandibular injuries from [...] Read more.
Background: Surgical care in conflict regions like Tigray, Ethiopia, faces severe challenges due to limited resources, infrastructural deficiencies, and high trauma burden. From 2019 to 2023, a multidisciplinary team conducted five humanitarian missions focusing on orthoplastic reconstruction of extremity and mandibular injuries from high-energy gunshot trauma. Methods: A retrospective analysis was performed on 98 patients who underwent free or pedicled flap reconstruction. Data included demographics, flap type, technique, complications, follow-up, and early clinical outcomes score as well as mobility scores. Flaps were harvested using loupes anastomosis performed using microscopes, depending on availability. Results: Among 98 patients (25.5% female, 74.5% male), 69 free flaps and 38 pedicled flaps were performed. Free fibula flaps (n = 54) included 33 mandibular and 21 extremity reconstructions. Additional flaps included ALT, gracilis, and LD flaps. Pedicled flaps included 18 fibula and 20 ALT/LD flaps. Mean age was 35.5 years; mean operative time was 429.5 min, with mandibular fibula transfers being longest. Microsurgical techniques were used in 34% of cases. Median follow-up was 10 months. Microsurgical complications occurred in 18.4%, mainly in fibula transfers (25.9%). Non-microsurgical issues included wound infections (n = 15), graft loss (n = 3), and bleeding (n = 5). Flap loss occurred in 16.3% overall. Early clinical outcome results were good (30.6%), acceptable (28.6%), and moderate (24.5%). Conclusions: Orthoplastic reconstruction using both free and pedicled flaps is feasible in low-resource, conflict settings. Despite infrastructural challenges, functional outcomes were achievable, supporting the value of adaptable microsurgical strategies in humanitarian surgery. Full article
(This article belongs to the Section Orthopedics)
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9 pages, 626 KiB  
Article
Potential Clinical Use of CytoSorb® for Ticagrelor and Rivaroxaban Elimination Prior to Emergency Orthopedic Surgery in Trauma Patients
by Gabriele Melegari, Fabio Gazzotti, Federica Arturi, Elisabetta Bertellini, Andrea Tognù, Domenico Pietro Santonastaso, Matteo Villani, Francesca Coppi, Fabrizio Fattorini, Fabio Catani and Alberto Barbieri
Life 2025, 15(7), 1065; https://doi.org/10.3390/life15071065 - 3 Jul 2025
Viewed by 448
Abstract
Background: Major orthopedic trauma in patients receiving anticoagulants such as ticagrelor or rivaroxaban poses a significant perioperative challenge, particularly in emergency contexts where bleeding risks are heightened and specific reversal agents may be unavailable. CytoSorb®, a hemoadsorption device, has demonstrated efficacy [...] Read more.
Background: Major orthopedic trauma in patients receiving anticoagulants such as ticagrelor or rivaroxaban poses a significant perioperative challenge, particularly in emergency contexts where bleeding risks are heightened and specific reversal agents may be unavailable. CytoSorb®, a hemoadsorption device, has demonstrated efficacy in cardiac surgery for drug removal. Its potential application in trauma surgery remains unexplored. Objective: This protocol describes a prospective clinical investigation assessing the feasibility and safety of CytoSorb® hemoadsorption for the preoperative removal of ticagrelor and rivaroxaban in trauma patients requiring urgent orthopedic surgery. Methods: The proposed intervention involves integrating CytoSorb® into a dedicated extracorporeal circuit under normothermic conditions (37 °C) with a blood flow of 150–200 mL/min for 300 min. Serial plasma samples will be collected at predefined intervals (0, 30, 60, 120, 240, 300 min) and drug concentrations. The primary outcome is the pharmacokinetic profile of drug clearance. Secondary endpoints include procedural safety, bleeding complications, and the feasibility of timely surgery. Expected Impact: The study aims to provide real-world data on the practical integration of CytoSorb® for anticoagulant removal in orthopedic trauma care, potentially facilitating earlier surgery and improving perioperative safety. Findings may inform future randomized trials and protocol standardization. Full article
(This article belongs to the Special Issue Advances in Anesthesia and Critical Care)
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19 pages, 1239 KiB  
Review
Trauma-Induced Coagulopathy: A Review of Specific Molecular Mechanisms
by Andrea Capponi and Carlo Rostagno
Diagnostics 2025, 15(11), 1435; https://doi.org/10.3390/diagnostics15111435 - 5 Jun 2025
Viewed by 806
Abstract
Trauma remains a leading cause of death and disability in adults, and about 20% of deaths occur due to intractable bleeding. Trauma-induced coagulopathy (TIC) is a complex hemostatic disorder characterized by an abnormal coagulation response, which can manifest as either a hypo-coagulable state, [...] Read more.
Trauma remains a leading cause of death and disability in adults, and about 20% of deaths occur due to intractable bleeding. Trauma-induced coagulopathy (TIC) is a complex hemostatic disorder characterized by an abnormal coagulation response, which can manifest as either a hypo-coagulable state, leading to excessive bleeding, or a hypercoagulable state, resulting in thromboembolic events and multiple organ failure. Early diagnosis and correction of hypocoagulability may be lifesaving. Replacement of coagulation factors using blood components as well as counteracting enhanced fibrinolysis with tranexamic acid in association with a strategy of damage control are the current practices in the management of TIC. Nevertheless, the improved comprehension of the several mechanisms involved in the development of TIC might offer space for a tailored treatment with improvement of clinical outcome. This review aims to outline the pathophysiology of TIC and evaluate both established and emerging management strategies. A thorough literature review was made with a specific emphasis on articles discussing the molecular mechanisms of trauma-induced coagulopathy. We utilized PubMed, Scopus, and Web of Science with the main search terms “trauma-induced coagulopathy”, “molecular mechanisms”, and “coagulation pathways”. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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13 pages, 793 KiB  
Article
Uterine Artery Embolization as an Alternative Therapeutic Option in Adenomyosis: An Observational Retrospective Single-Center Study
by Melinda-Ildiko Mitranovici, Dan Costachescu, Dan Dumitrascu-Biris, Liviu Moraru, Laura Georgiana Caravia, Florin Bobirca, Elena Bernad, Viviana Ivan, Adrian Apostol, Ioana Cristina Rotar and Lucian Marginean
J. Clin. Med. 2025, 14(11), 3788; https://doi.org/10.3390/jcm14113788 - 28 May 2025
Viewed by 689
Abstract
Adenomyosis is a benign gynecologic disease that mainly affects women aged 30–50 years old. Background: This pathology is characterized by glands and stroma of the endometrium that enter the myometrium and is confirmed through histopathological examination after hysterectomy. Transvaginal ultrasound is the [...] Read more.
Adenomyosis is a benign gynecologic disease that mainly affects women aged 30–50 years old. Background: This pathology is characterized by glands and stroma of the endometrium that enter the myometrium and is confirmed through histopathological examination after hysterectomy. Transvaginal ultrasound is the most accepted imaging approach for the diagnosis and classification of adenomyosis. Existing medical treatments are not curative and are associated with several side effects. Uterine artery embolization is an alternative treatment for controlling the symptoms of adenomyosis with less trauma while preserving the uterus. Methods: The aim of our study was to observe the utility of uterine artery embolization (UAE) compared to hysterectomy in specific cases of adenomyosis. A retrospective cohort study was carried out between February 2024 and April 2025. We included 52 patients in our study: 27 opted for hysterectomy, while the other 25 chose to receive uterine artery embolization between January 2017 and December 2018. Clinical follow-up was assessed using a questionnaire regarding symptomatic changes in menorrhagia, pelvic pain, and quality of life before and after the surgical procedure. Statistical analyses were performed. Results: Patients opted for hysterectomy in cases of severe abnormal uterine bleeding before surgery that severely affected quality of life (p < 0.03 and p < 0.001). After surgery, pelvic pain improved for women who underwent UAE, but patients also reported no pelvic pain after hysterectomy. Furthermore, mild to moderate abnormal uterine bleeding was reported in cases of UAE, and bleeding stopped completely for women who had their uterus removed (p < 0.001). Quality of life improved for both groups and was reported as being good after the interventions. Conclusions: Embolization remains an alternative therapeutic option in adenomyosis but not a substitute for hysterectomy. This was concluded based on a case-by-case evaluation, depending on the desire for pregnancy, with a focus on improved clinical outcomes. Full article
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10 pages, 1243 KiB  
Case Report
A Case of Rheumatoid Arthritis Complicated by Compression of the Popliteal Artery and Tibial Nerve Due to an Organized Hematoma in the Popliteal Fossa: A Case Report and Literature Review
by Gi Beom Kim, Min Cheol Chang and Hyun-Je Kim
Diagnostics 2025, 15(10), 1265; https://doi.org/10.3390/diagnostics15101265 - 16 May 2025
Cited by 1 | Viewed by 584
Abstract
Background/Objectives: Among the various types of masses that can cause compression, hematomas are a relatively common but often overlooked cause. Rheumatoid arthritis (RA) is associated with bleeding problems due to vascular inflammation, platelet dysfunction, impaired production of clotting factors, and medication use. Case [...] Read more.
Background/Objectives: Among the various types of masses that can cause compression, hematomas are a relatively common but often overlooked cause. Rheumatoid arthritis (RA) is associated with bleeding problems due to vascular inflammation, platelet dysfunction, impaired production of clotting factors, and medication use. Case Presentation: We report a case of a 76-year-old woman with RA who developed vascular and neurological symptoms in her right lower leg due to compression of the popliteal artery and tibial nerve by an organized hematoma in the popliteal fossa. She experienced swelling, pain, and plantar flexor weakness in the affected leg with no history of trauma. Magnetic resonance imaging revealed a mass measuring 1.2 × 1.0 × 3.0 cm in size in the right popliteal fossa that was in contact with the popliteal artery and tibial nerve on its posterolateral aspect. Electrodiagnostic examination revealed that the right tibial neuropathy developed most probably around the knee level. Surgical excision of the hematoma resulted in almost complete resolution of symptoms, and excisional biopsy disclosed findings of an organized hematoma. We confirmed that the patient’s symptoms were induced by compression of the popliteal artery and tibial nerve due to the organized hematoma in the right popliteal fossa. Conclusions: This case report emphasizes the importance of considering space-occupying lesions, such as organized hematomas, in patients with RA who develop neurological and vascular symptoms. Full article
(This article belongs to the Special Issue Diagnosis and Management of Musculoskeletal Disorders)
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11 pages, 2178 KiB  
Article
Hemorrhage Versus Thrombosis: A Risk Assessment for Anticoagulation Management in Pelvic Ring and Acetabular Fractures—A Registry-Based Study
by Christof K. Audretsch, Tina Histing, Anna Schiltenwolf, Sonja Seidler, Andreas Höch, Markus A. Küper, Steven C. Herath, Maximilian M. Menger and Working Group on Pelvic Fractures of the German Trauma Society
J. Clin. Med. 2025, 14(10), 3314; https://doi.org/10.3390/jcm14103314 - 9 May 2025
Viewed by 401
Abstract
Background: The increasing incidence of pelvic ring and acetabular fractures represents a major challenge in the field of trauma surgery. Hemorrhage and thrombosis are among the most severe complications associated with these injuries. The common instability of those fractures, together with an anatomic [...] Read more.
Background: The increasing incidence of pelvic ring and acetabular fractures represents a major challenge in the field of trauma surgery. Hemorrhage and thrombosis are among the most severe complications associated with these injuries. The common instability of those fractures, together with an anatomic proximity to blood vessels, increases the risk of perioperative bleeding. Vascular wall irritation during surgery additionally adds to a substantial risk for thrombotic events. Therefore, evaluating the risk for hemorrhage and thrombosis in pelvic ring and acetabular fractures is vital to identify an adequate anticoagulation management. Methods: The incidence of hemorrhagic and thrombotic events, as well as the association of patient characteristics with the investigated outcomes of 16,359 cases, were analyzed retrospectively using data from the German Pelvic Trauma Registry. Moreover, a risk assessment survey was conducted among traumatologists experienced in pelvic ring and acetabular surgery. The results were compared to those of the registry study. Results: A high rate of thrombotic events was found in the middle-age decade (41–50 years). In patients with an age ≤ 40 and >50 years, hemorrhage complications predominated. The logistic regression identified pelvic ring fractures in geriatric patients, acetabular fractures, and Injury Severity Score (ISS) ≥ 16 to be associated with bleeding complications. Factors associated with thrombosis included pelvic ring fractures in non-geriatric patients, acetabular fractures in geriatric and non-geriatric patients, ISS, and male gender. The survey demonstrated that preoperatively, the risk for hemorrhage was considered more significant. Perioperatively, however, thrombosis was regarded as more important. Conclusions: Separate guidelines for prophylactic anticoagulation in pelvic ring and acetabular fractures that also consider individual patient characteristics, such as age, gender, and ISS, are necessary to improve perioperative management and reduce the morbidity and mortality associated with these injuries. Full article
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10 pages, 2258 KiB  
Article
Venous Malformations as a Rare Cause of Knee Joint Pain in Children and Young Adults: Clinical and Radiological Manifestations
by Adam Dobek, Marcin Strzelczyk, Ludomir Stefańczyk, Dobromiła Barańska, Jan Sokal and Przemysław Przewratil
Children 2025, 12(4), 514; https://doi.org/10.3390/children12040514 - 16 Apr 2025
Viewed by 800
Abstract
Background: Venous malformations (VMs) are congenital vascular abnormalities characterized by tortuosity, slow blood flow, and gradual growth. Intra-articular venous malformations (IAVMs) of the knee are rare and often present with symptoms similar to juvenile idiopathic arthritis (JIA) or late sequelae of trauma. [...] Read more.
Background: Venous malformations (VMs) are congenital vascular abnormalities characterized by tortuosity, slow blood flow, and gradual growth. Intra-articular venous malformations (IAVMs) of the knee are rare and often present with symptoms similar to juvenile idiopathic arthritis (JIA) or late sequelae of trauma. VM in children is commonly misdiagnosed as hemangioma. This study aims to analyze the clinical and MRI features of IAVM in the knee joint. Methods: This retrospective study analyzed patients from a reference unit for the treatment of vascular malformations in the Pediatric Surgery Department. The group was collected starting from the year 2014 until the 100th patient was identified in the year 2018, all with MRI-confirmed VM based on a predefined protocol. From this group, 19 patients with lower limb symptoms were identified, and 9 patients with VM involving the knee joint were selected for further analysis. Results: The most common symptoms in IAVM patients were pain and swelling, chronic in five (55%) and intermittent in four (45%). Four (45%) reported worsening pain during or after physical activity. A history of intra-articular bleeding was noted in five (55%), leading to mild knee contracture (10° reduction in extension) and decreased mobility. Limb deformities were observed in eight (89%). Diffuse VMs, affecting both intra- and extra-articular tissues, were present in eight (89%), involving the thigh in seven (78%), crus in five (56%), gluteal muscles in three (33%), and foot tissues in one (11%). The suprapatellar recess and Hoffa’s fat pad were involved in all patients (100%). Conclusions: IAVMs are rare causes of knee dysfunction in children and young adults, particularly in cases of unexplained pain, swelling, or instability. They should be considered in the differential diagnosis of hemophilic arthropathy, JIA, or late post-traumatic sequelae. Untreated IAVMs can lead to intra-articular bleeding, cartilage degeneration, and disability. Early diagnosis via MRI and ultrasound is crucial to identifying IAVMs and preventing joint degeneration. Timely treatment helps avoid further damage and long-term disability. Full article
(This article belongs to the Section Pediatric Surgery)
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28 pages, 2866 KiB  
Review
Gastrointestinal and Intra-Abdominal Mucormycosis in Non-Haematological Patients—A Comprehensive Review
by Benoît Henry, Alain Lefevre Utile, Stephane Jaureguiberry and Adela Angoulvant
J. Fungi 2025, 11(4), 298; https://doi.org/10.3390/jof11040298 - 9 Apr 2025
Cited by 1 | Viewed by 1043
Abstract
Intra-abdominal and gastrointestinal mucormycosis are less frequent than rhino-orbito-cerebral and pulmonary mucormycosis, but highly lethal. Their diagnosis remains challenging due to the non-specific clinical presentation. We collected English-language cases of intra-abdominal and gastrointestinal mucormycosis in non-haematological and non-neonatal patients published up to October [...] Read more.
Intra-abdominal and gastrointestinal mucormycosis are less frequent than rhino-orbito-cerebral and pulmonary mucormycosis, but highly lethal. Their diagnosis remains challenging due to the non-specific clinical presentation. We collected English-language cases of intra-abdominal and gastrointestinal mucormycosis in non-haematological and non-neonatal patients published up to October 2024. This review analysed the epidemiological, clinical, and therapeutic charts of 290 cases. A proportion of 53.4% were reported from India and the USA. The main predisposing conditions were diabetes, solid organ transplant, ICU, and corticosteroid treatment. The most common site was the stomach (53.8%). Gastrointestinal perforation, skin breakdown, and abdominal wall infection were sources of intra-abdominal localisation. The most common symptoms were abdominal pain, vomiting, and gastrointestinal bleeding. The diagnosis relied on histology (93.8%), mycology with microscopy and culture (38.8%), and molecular methods (9.9%). Mortality (52.9%) was lower when treatment was intravenous amphotericin B, combined or not with surgery. Prompt treatment, essential for a favourable outcome, relies on early suspicion and diagnosis. Gastrointestinal and intra-abdominal mucormycosis should also be suspected in patients admitted in ICU with ventilation/nasogastric tube and corticosteroids and those with abdominal trauma or surgery, presenting abdominal distension, pain, and GI bleeding. Mycological diagnosis including direct examination, culture and Mucorales qPCR on tissue should assist with rapid diagnosis and thus treatment. Full article
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16 pages, 624 KiB  
Review
Recent Advances in Prehospital and In-Hospital Management of Patients with Severe Trauma
by Jung-Youn Kim and Oh Hyun Kim
J. Clin. Med. 2025, 14(7), 2208; https://doi.org/10.3390/jcm14072208 - 24 Mar 2025
Viewed by 3980
Abstract
Background: Trauma is a major global public health concern. Many countries are working to reduce preventable deaths; however, the mortality rate remains higher than their goal, indicating a need for continuous development in trauma care, including further improvements across the system. This article [...] Read more.
Background: Trauma is a major global public health concern. Many countries are working to reduce preventable deaths; however, the mortality rate remains higher than their goal, indicating a need for continuous development in trauma care, including further improvements across the system. This article explores recent developments and updated guidelines for both prehospital emergency care and in-hospital trauma management, emphasizing evidence-based and patient-centered approaches. Current concepts: In the prehospital phase, the primary focus is on early and aggressive hemorrhage control using techniques such as tourniquet application, wound packing, and permissive hypotension as standard practices. Advancements in this field, including intraosseous vascular access and tranexamic acid administration, have improved patient outcomes. The emphasis on structured assessments, particularly “circulation, airway, breathing” (CAB) assessments, underscores the importance of managing life-threatening hemorrhages. During the in-hospital phase, the primary focus is on controlling bleeding. Protocols emphasize the judicious administration of fluids to prevent over-resuscitation and mitigate the risk of exacerbating coagulopathy. Efficient transfusion strategies are implemented to address hypovolemia, while ensuring balanced ratios of blood products. Furthermore, the implementation of advanced interfacility transfer systems and communication tools such as “Situation, Background, Assessment, Recommendation” (SBAR) plays a pivotal role in optimizing patient care and reducing delays in definitive treatment. Discussion and Conclusions: This review highlights the importance of implementing advanced strategies to align with international standards and further decrease the rate of preventable trauma-related deaths. Strengthening education and optimizing resource allocation for both prehospital and hospital-based trauma care are essential steps toward achieving these objectives. Full article
(This article belongs to the Section Emergency Medicine)
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Article
Time Variable Models of Severe Hemorrhagic Shock in Rats
by Matthew B. Barajas, Takuro Oyama, Miriam J. K. Walter, Masakazu Shiota, Zhu Li and Matthias L. Riess
Life 2025, 15(4), 522; https://doi.org/10.3390/life15040522 - 22 Mar 2025
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Abstract
Background: Classical teaching dictates that damage control resuscitation is ideally implemented within the first or ‘golden’ hour after trauma-related hemorrhage. Given the heterogeneity of trauma, varied models must be utilized to guide ongoing investigation. We sought to determine exactly what happens during the [...] Read more.
Background: Classical teaching dictates that damage control resuscitation is ideally implemented within the first or ‘golden’ hour after trauma-related hemorrhage. Given the heterogeneity of trauma, varied models must be utilized to guide ongoing investigation. We sought to determine exactly what happens during the ‘golden hour’ by varying hemorrhage and down times and mimicking venous or arterial bleeding while varying oxygen therapy, a readily available pre-hospital intervention, on survival in a small-animal rodent model. Methods: Rats were bled by 40% of their blood volume over 30 or 60 min, with varied ‘down-times’ of 30, 45, or 60 min. FiO2 was administered at 21% or 40%, mimicking nasal cannula. Multiple linear regression was performed between the independent variables and each measured outcome. Sub-group analyses were stratified by survival. Results: There was no statistically significant variation in end-organ insult (lactate), cardiac functioning (cardiac output or left ventricle fractional area of change), mean arterial pressure at end experiment, survival, or survival times among the groups. Conclusions: This study adds to the data against an all-encompassing golden hour, as even a rapid hemorrhage with long down time did not decrease survival. Furthermore, we add to the body of literature in this field by examining cardiac markers of injury with transthoracic echocardiography. Full article
(This article belongs to the Special Issue Clinical Update for Resuscitation Science)
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