Pulmonary artery pseudo-aneurysm (PAPA) resulting from chest trauma is uncommon. Seventeen cases have been described in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]: 12 of these resulted from penetrating injuries [1,2,4,5,7,8,12,13,[15][16][17], 4 from blunt injuries [3,9,11,14], and 1 case that involved penetrating chest trauma with simultaneous pulmonary artery and pulmonary vein pseudo-aneurysm [10].In 2006, Reade et al. first described the case of blunt traumatic main PAPA, detected on initial computed tomography (CT) scan, that was treated non-operatively [14]. In every reported case, the traumatic PAPA was repaired operatively by means of local resection (aneurysectomy), ligation of vessels, lobectomy or embolisation [5,15].The development and improvement of imaging techniques, especially multislice CT scan, have permitted the diagnosis of 'new injuries' in trauma patients. These injuries identified with modern diagnostic technology may represent a challenge to the surgeon, who has to determine or characterise their nature and apply the appropriate management.Here, we report two cases of pulmonary vessel pseudo-aneurysm in blunt-trauma patients who were admitted to our emergency surgical service (ESS) and were successful treated non-operatively. Case 1A 37-year-old man was involved in a collision with a car while riding a bicycle and arrived at our ESS without any additional information. The patient was not alert upon his admission to the emergency room. An orotracheal intubation was performed. The chest physical examination showed multiple thoraco-abdominal excoriations, and bilateral vesicular murmur was present with diffuse bruises. The cardiocirculatory system was normal on physical examination, and the focussed assessment with sonography for trauma (FAST) showed fluid in hepatorenal and pelvic fields. Pelvic and rectal examination was normal, and the urine was clear. The Glasgow Coma Scale (GCS) score was 8 before sedation. Right tibia and fibula fractures (Gustilo grade IIIa) were observed.A cranial/thoracic CT scan showed multiple facial fractures (nasal, maxillary, right zygomatic and bilateral orbital), as well as a small right haemo-pneumothorax, a right PAPA measuring 24 mm  21 mm  23 mm (23-mm extension) and a right inferior pulmonary vein pseudo-aneurysm measuring 10 mm (Fig. 1). An abdominal/ pelvic CT showed a small right hepatic lobe laceration, a right adrenal haematoma and small liquid collections in hepatic and pelvic fields.The patient underwent external fixation of tibia and fibula fractures performed by the orthopaedic surgery group. Facial fractures as well as the thoracic and abdominal lesions were managed non-operatively. The patient received care in the trauma intensive care unit (ICU), where he required continuous noradrenalin infusion for 3 days. Eight days after admission, the patient had internal fixation of tibia and fibula fractures. No specific treatment for the pseudo-aneurysm was performed. A repeated CT scan performed 22 days after admissio...
The single vehicle rollover accident is a highly complex crash mode and there is growing concerns about its incidents and consequences in central Australia. The aim of this paper is to assess: 1 The incidence and injury patterns of rollover accidents 2 Pre rollover characteristics on rollover propensity 3 The injury severity and outcome of rollover accidents The absence of speed limit, unfenced roads, vast distances traveled, unsealed roads and high use of alcohol makes the spectrum of MVA' s in NT unique.In this two year period of study from Jan 2004 -Dec 2005, there were 470 motor vehicle accidents of which 126 were single vehicle rollover accidents. 132 patients were admitted; 73 NT residents of which 45 were of aboriginal origin and 14 were international tourists. There were 37 deaths in Central Australian roads and 20 were due to single vehicle rollover accidents. None of the deaths occurred at the Alice Springs hospital . Most rollover accidents occur at a speed above 100 km/h. 24 patients had an ISS > 15 and 35% of all injuries were to head, neck and shoulder. Rollovers occurred when the vehicle left the road way and encountered a tripping mechanism such as soft dirt or loose gravel. Those who were belted fared better than those unbelted occupants. Completely ejected occupants were all unbelted. Mean time to hospital from time of accident was 8Hrs. Primary prevention strategies need to involve remote communities, tourists traveling in central Australia and address alcohol and restraint use.
Background:The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) scoring system, derived from a heterogeneous population, has been used successfully as an audit tool, but it has appeared to over-predict mortality in low-risk groups for which an alternative system, the Portsmouth Predictor Equation for Mortality (P-POSSUM) was designed and used successfully. In this prospective study, we compared these two equations in predicting death and tested their validity in predicting morbidity and mortality in patients undergoing emergency laparotomy in a tertiary hospital. Methods: Eighty-two patients who underwent emergency laparotomy were included in this study. Actual morbidity and mortality rates were compared with the predicted mortality and morbidity rates using both POSSUM and P-POSSUM equations by linear regression and exponential methods of analysis. Results: POSSUM equation significantly over-predicted both morbidity and mortality when linear regression analysis was used, but predicted well when exponential analysis was used. Prediction of mortality by P-POSSUM was good using both linear and exponential analyses, and exponential method was better than linear regression analysis. Conclusion: P-POSSUM is a better equation than POSSUM in predicting mortality, and exponential method is better than linear regression analysis. Both equations are useful tools for risk-adjusted surgical audit of patients undergoing emergency laparotomy.Problem: There are low rates of treatment of osteoporosis following hip fractures in the elderly. Design: Controlled before-after trial of the ortho-geriatric-led 'ICHIBAN' program. Data were collected by a blinded observer in 2 phases: over the year before and 10-months following intervention. The data is collected from orthopaedic wards in a large metropolitan hospital. Improvement Measures: Rate of measurement: 25-hydroxyvitamin levels (25-OHD), thyroid-stimulating hormone (TSH), and parathyroid hormone (PTH). Prescription of osteoporosis medications (vitamin D, calcium supplements, oral bisphosphonates). Documentation of rationale for non-prescription. Conclusion: Three-hundred-and-fifty-two patients presented during a period of 22-months: 202 during 12-months prior to and 150 in the 10 months following intervention. Investigation of 25-hydroxyvitamin levels increased from 31.6% to 71.2%, focused tests for secondary osteoporosis (TSH, PTH) from 9.4% to 37.1%, prescription of osteoporosis medications improved from 40.1% to 78.2% for vitamin D, 41.3% to 75.6% for calcium supplements and 34.8% to 53.8% for oral bisphosphonates (p < 0.001). Ninety percent documented rationale for non-prescription of treatment. A 6-month follow-up of the first 60 patients following intervention showed that 51.6% were still on appropriate treatment. The ICHIBAN program has improved delivery of osteoporosis care to appropriate at-risk patients following hip fracture.
The single vehicle rollover accident is a highly complex crash mode and there is growing concerns about its incidents and consequences in central Australia. The aim of this paper is to assess: 1 The incidence and injury patterns of rollover accidents 2 Pre rollover characteristics on rollover propensity 3 The injury severity and outcome of rollover accidents The absence of speed limit, unfenced roads, vast distances traveled, unsealed roads and high use of alcohol makes the spectrum of MVA' s in NT unique.In this two year period of study from Jan 2004 -Dec 2005, there were 470 motor vehicle accidents of which 126 were single vehicle rollover accidents. 132 patients were admitted; 73 NT residents of which 45 were of aboriginal origin and 14 were international tourists. There were 37 deaths in Central Australian roads and 20 were due to single vehicle rollover accidents. None of the deaths occurred at the Alice Springs hospital . Most rollover accidents occur at a speed above 100 km/h. 24 patients had an ISS > 15 and 35% of all injuries were to head, neck and shoulder. Rollovers occurred when the vehicle left the road way and encountered a tripping mechanism such as soft dirt or loose gravel. Those who were belted fared better than those unbelted occupants. Completely ejected occupants were all unbelted. Mean time to hospital from time of accident was 8Hrs. Primary prevention strategies need to involve remote communities, tourists traveling in central Australia and address alcohol and restraint use.
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