Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups ( p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients.

Treatment of iliac venous obstruction with balloon angioplasty and stenting appears to be a minimally invasive and safe therapeutic approach in patients with PTS offering quick symptomatic relief, good patency and minimal morbidity.

Successful management of subclavian and axillary artery injuries requires prompt diagnosis because the occult nature of these injuries necessitates a high index of suspicion. Although revascularization procedures are often successful, it is the associated neurological, orthopedic, and soft tissue injuries that affect the functional outcome of the limb.

No abstract

COVID-19 is a new disease, based on currently available limited information, older adults and people of any age who have severe underlying medical conditions may be at higher risk for severe illness from COVID-19. People of all age groups are also at risk. Healthcare providers have always been the professionals most exposed to the risk of contracting to any kind of infection due to the nature of their profession. Elective interventions have been postponed to give care of patients with COVID-19. However, some interventions cannot be delayed, such as trauma surgery, acute abdomen, and emergency endoscopies. To maintain the sustainability of the healthcare system, the protection of healthcare providers should be the top priority. On the other hand, patients, who need emergency healthcare, should also be provided with appropriate treatment. Healthcare professionals should choose a treatment method appropriately in the circumstances to protect themselves and their patients as much as possible. This paper aims to summarize how a surgeon may act appropriately when an intervention is inevitable during the COVID-19 pandemic.

Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis.

A higher oxidative stress in the valvular tissue may contribute to venous stasis ulcer formation.

Conclusion:Transcranial Doppler (TCD) detection of circulating microemboli can be improved by injection of appropriately targeted microbubbles.Summary: Some ultrasound contrast agents adhere selectively to specific pathologic materials, such as plaque or thrombus. Targeting specific pathologic materials for adherence by microbubbles may allow TCD to distinguish different types of microembolic material. In this study, the authors sought to determine whether TCD detection of circulating thrombus emboli could be enhanced by targeted microbubbles.A technique of binding microbubbles to the surface of thrombus was developed. Binding was confirmed by scanning electron microscopy. Using an in vitro pulsatile flow model, control and targeted microbubbles were introduced to thrombus. Thrombus and tissue mimicking material were then circulated under pulsatile-flow conditions using the model. TCD was used to detect embolic symbols before and after induction of the microbubbles.TCD signal intensities were enhanced by the targeted microbubbles up to 13 dB. Microbubbles were observed to bind moving thrombus even when injected in low concentrations (approximately 36 bubbles per 100 mL). The microbubbles were retained on the thrombus under pulsatile-flow conditions. TCD signal intensity was not enhanced by similar size pieces of tissue mimicking material not enhanced by injection of targeted microbubbles.Comment: Targeted microbubble enhancement of TCD emboli detection may allow determination of what TCD really detects during manipulation of the carotid bifurcation. It may eventually be possible to design targeted therapies to prevent embolization of specific materials.