Complications of enteral access.

Die Versorgung schwerstverletzter Patienten im Schockraum bedeutet fur das multidisziplinare Behandlungsteam einen strukturierten Evaluationsprozess in einen zielgerichteten Behandlungsprozess zu uberfuhren. Neben dem Faktor Zeit und dem Erkennen vital bedrohlicher Verletzungen, die haufig unter dem Begriff „deadly six“ zusammengefasst werden, sollten aber auch sog. „Bagatellverletzungen“ nicht ubersehen werden, da sie die Lebensqualitat nach Trauma mitunter entscheidend beeinflussen konnen. Die S3-Leitlinie Polytrauma erhebt nicht den Anspruch auf Vollstandigkeit. Wichtige Inhalte, wie z. B. die Versorgung von Kindern sind bisher noch nicht in die Leitlinie eingeflossen, werden aber fur die Uberarbeitung fest eingeplant.

S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung

Purpose of review Orbital fractures are usually associated with ocular and intracranial injuries. The recent literature on orbital fractures is analyzed with emphasis on epidemiology, assessment, and surgical management. Recent findings In most countries, traffic accidents are the leading cause of orbital fractures. Orbitozygomatic fractures are extremely frequent but rarely addressed in the ophthalmic literature. CT scanning remains the gold standard for assessing orbital fractures, especially with the new CT technology (multislice CT), which has improved the acquisition of coronal images of the orbit without the need for hyperextension of the neck. Several different surgical strategies are used to repair orbital fractures. Porous polyethylene implants continue to be approved by most surgeons. Summary Orbital fractures are usually part of more complex midfacial trauma. Depending on the main characteristics of the trauma, orbital fractures are managed by different specialists who adopt distinct surgical approaches. Taking into consideration that most complications of these fractures are related to the globe, oculoplastic surgeons in collaboration with other medical specialists are in a prime position to assess and manage these cases.

Epidemiology and management of orbital fractures

Background:Patients with panfacial fractures comprise a small portion of the overall facial fracture patient population. Because of the forces necessary to cause panfacial injury, these patients often have other concomitant injuries. The timing of operative facial fracture management remains controv

Concomitant injuries in patients with panfacial fractures.

Recognizing the importance of improving efficiency measurement of health care quality, the Agency for Healthcare Research and Quality has sponsored this systematic review and analysis of available measures.

Identifying, Categorizing, and Evaluating Health Care Efficiency Measures

Background Traumatic craniofacial and skull base injuries require a multidisciplinary team approach. Trauma physicians must evaluate carefully, triage properly, and maintain a high index of suspicion to improve survival and enhance functional recovery. Frequently, craniofacial and skull base injurie

Craniofacial and skull base trauma

We report the case of a B-cell type pituitary lymphoma in a 65 year-old male immunocompetent patient who presented with hypogonadotropic hypogonadism and central hypothyroidism and subsequently developed pulmonary lymphoma. Only three cases of pituitary lymphoma have been previously reported, one in a patient with acquired immunodeficiency syndrome, one case of T-cell lymphoma reported in the Japanese literature, and one case of B-cell lymphoma. The previously reported immunocompetent patients presented with signs and symptoms of optic chiasm compression as contrasted to our patient's endocrinologic presentation. B-cell lymphoma of the pituitary gland is a exceedingly rare though distinct clinical entity.

Pituitary lymphoma: a case report and literature review.

A dedicated craniofacial trauma team improves efficiency and reduces cost.

Patients with hepatic encephalopathy are at particular risk for aspiration when given oral or gastric feedings. An ideal strategy might combine distal enteral feeding with proximal gastric decompression, which is offered by a nasogastrojejunal (NGJ) feeding tube. One objective was to determine the efficacy and safety of endoscopically placed NGJ feeding tubes in patients with hepatic encephalopathy. Charts of patients who underwent NGJ tube placements between April 1997 and January 2000 were retrospectively reviewed. Two endoscopic techniques ("push" and "pull") were used. Eighteen patients (nine male and nine female) underwent 32 procedures. Twelve patients had undergone liver transplantation, four had decompensated cirrhosis, and two had fulminant hepatic failure. Twenty procedures used the push technique and 12 required the pull technique. The insertion time was shorter for the push technique compared with the pull technique (21.8 vs 39.6 min, P < 0.05). Enteral feedings were begun at an average of 5.2 hours after tube placement. The tubes remained in place for an average of 13.9 days. Complications related to the NGJ tubes included self-removal in eight, tube clogging in five, proximal migration in four, and intraduodenal migration of the gastric port in one. No aspiration episodes occurred. We conclude that NGJ feeding tubes may be placed endoscopically as a bedside procedure for patients with hepatic encephalopathy and provide a safe, efficacious, and rapid route for enteral nutrition in these patients.

Endoscopically placed nasogastrojejunal feeding tubes: a safe route for enteral nutrition in patients with hepatic encephalopathy.

Congenital teratoma of the oropharyngeal cavity is a unique clinical entity that poses immediate threats to the neonate in the postpartum period. Establishment of a secure airway is a primary goal after delivery; complete surgical resection is the subsequent guiding principle of management. Even more rare than teratomas confined to the oropharynx are tumors that extend into the intracranial cavity during development. Descriptions of these lesions in the medical literature are uncommon. In the majority of these reports, the tumors are associated with stillbirth, perinatal death, or significant morbidity after attempted resection. We present the rare case of a patient with congenital oropharyngeal teratoma with intracranial extension who has demonstrated long-term survival without any neurological or functional deficits. A unique delayed staged approach to resection of the extracranial and intracranial components of the tumor is described.

Congenital teratoma of the oropharyngeal cavity with intracranial extension: case report and literature review.

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