IntroductionSevere trauma causes damage to the protective barriers of the organism, and thus activates immunological reaction. Among substances secreted during this process pro-inflammatory cytokines are of high importance.The aim of the studySevere trauma causing multiple injuries is more likely to lead to particularly intensive inflammatory reaction, which can sometimes lead to serious complications, even life-threatening. The aim of the study is to determine those parameters which may serve as predictors of infectious complications and to enable estimation of the patient’s immunological status before the decision to introduce elective procedures.Material and methodsThe study population included patients with multiple trauma treated in the Department of Trauma Surgery of the Medical University of Gdańsk. The severity of injuries was evaluated with commonly used numerical scales (Revised Trauma Score – RTS, Injury Severity Score – ISS, Glasgow Coma Scale – GCS). Blood samples were collected on the first, second, and fifth day after injury. Evaluated parameters: C-reactive protein (CRP), the level of cytokines: IL-8, IL-1β, IL-6, TNF, IL-12p70, and IL-10. Control population: individuals without injury.ResultsEvaluation of IL-6, IL-8, and CRP levels in patients with multiple trauma in the early period after injury (2-3 days) could be considered as a predictor of delayed infection (5-10 days). CRP level, being cheap and commonly accessible, can be used in clinical practice enabling identification of patients at higher risk of infectious complications and introduction of appropriate treatment and prevention. The analysis of the mentioned parameters may contribute to choosing an appropriate management strategy, including “timing” depending on the patient’s biological status.
Background: Trauma patients with severe and moderate central nervous system (CNS) injuries are at risk of immunologically derived complications (infection, "2nd-hit injuries")
Necrotising skin and soft tissues infections are most commonly bacterial in origin. However, saprophytic fungi of the class Zygomycetes, family Mucoraceae, can cause highly aggressive infections (mucormycoses) mainly in immunocompromised patients. Severe trauma is one of the major risk factors for mucormycosis. Fungal traumatic wound infection is an unusual complication associated with crash limb injury. This report describes a case of serious necrotising soft tissue infection caused by Mucor sp following primary fungal environmental wound contamination in a multiply injured patient. Despite undelayed diagnosis and proper treatment (surgical debridement and limb amputation, amphotericin B therapy) the patient presented a fatal outcome.
Gastrointestinal stromal tumour (GIST), within its definition, is a gastrointestinal (GI) mesenchymal tumour containing spindle cells and showing CD 117 immunopositivity. The incidence of GISTs is estimated at 10-20/million. GISTs occur typically in people over 50 years of age. Over 95% of primary GISTs are solitary. Rarely, GISTs are multifocal and occur in young adults and children. A case of a 60-year-old women with double GIST of the stomach is reported here. The patient approached her general practitioner because of stomach ache, chronic diarrhoea and weight loss. Ultrasonography showed an abdominal tumour. During gastroscopy a submucosal tumour in the antral part of the stomach was found. Computed tomography revealed a pathological lesion between the stomach and the liver and an intramural tumour of the stomach. Two stomach tumours were found, and a Bilroth I gastrectomy was performed. Histopathological examination showed GIST in both tumours. This case shows that multifocal GISTs of the stomach can arise in older patients.
In the follow-up study of patients with pelvic fractures, rupture of the posterior urethra is registered in 3–25% of cases (Koraitim et al., 1996). The diagnostic gold standard for the assessment of hemodynamically stable trauma patients is contrast-enhanced CT scan, especially helical CT. Nevertheless, simultaneous suprapubic cystography and ascending urethrograms (the so-called up-and-downogram) are the investigation of choice in assessing the site, severity, and length of urethral injuries. (Carlin and Resnick, 1995) This paper discusses the evaluation and diagnosis of urethral injury in multiple-trauma patient.
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