IntroductionUreteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management.Literature reviewEighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%.ConclusionThe mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.

The authors report the largest series of patients treated with this therapy for post-sternotomy sternal wounds and believe it is safe and effective as a first-line therapy in the management of sternal wounds. The mortality rate from their study represents the patients' underlying disease process and comorbidities and is not a reflection of complications associated with the therapy. Vacuum-assisted closure therapy has been shown to decrease wound edema, decrease the time to definitive closure, and reduce wound bacterial colony counts. The authors have implemented the therapy for most patients with sternal wounds/mediastinitis at their institution, and believe it should be a standard protocol in the first-line management of these types of wounds.

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This is the first demonstration that prehospital HRV (specifically SDNN) predicts base excess and operating room life-saving opportunities. HRV triages and discriminates severely injured patients better than routine trauma criteria or en-route prehospital vital signs. HRV may be a useful civilian or military triage tool to avoid unnecessary helicopter evacuation for minimally injured patients. A prospective, randomized trial in a larger patient population is indicated.

Decreased VLF is an independent predictor of mortality and morbidity in hemodynamically stable trauma patients. Other time and other frequency domain variables correlated with some, but not all, outcomes. All were heavily influenced by factors that alter autonomic function, especially patient age.

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No associated survival benefit for surgery in the treatment in gastrointestinal lymphoma was observed. Determination of lymphoma should preclude surgical resection. Nonetheless, inadvertent extirpative surgery or in association with perforation does not appear to increase mortality.

Background: emergent cricothyroidotomy remains an uncommon, but life-saving, core procedural training requirement for emergency medicine (em) physician training. we hypothesized that, although most cricothyroidotomies occur in the emergency department (ed), they are rarely performed by em physicians.Methods: we conducted a retrospective analysis of all emergent cricothyroidotomies performed at two large level one trauma centers over 10 years. operators and assistants for all procedures were identified, as well as mechanism of injury and patient demographics were examined.Results: Fifty-four cricothyroidotomies were performed. Patients were: mean age of 50, 80% male and 90% blunt trauma. the most common primary operator was a surgeon (n = 47, 87%), followed by an emergency medical services (ems) provider (n = 6, 11%) and a em physician (n = 1, 2%). in all cases, except those performed by ems, the operator or assistant was an attending surgeon. all ems procedures resulted in serious complications compared to in-hospital procedures (p < 0.0001).Conclusions: 1. Pre-hospital cricothyroidotomy results in serious complications. 2. despite the ubiquitous presence of emergency medicine physicians in the ed, all cricothyroidotomies were performed by a surgeon, which may represent a serious emergency medicine training deficiency.