Life After Near Death: Long-Term Outcomes of Emergency Department Thoracotomy Survivors.

Life after near death: Long-term outcomes of emergency department thoracotomy survivors.

J Trauma Acute Care Surg. 2013 May; 74(5): 1315-20
Keller D, Kulp H, Maher Z, Santora TA, Goldberg AJ, Seamon MJ

Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors.Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist).After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening.Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the “futility” of EDT in our most severely injured patients.Prognostic and epidemiologic study, level III. HubMed – rehab


Endobronchial valves for treatment of bronchopleural fistula in granulomatous polyangitis: a longitudinal case report.

J Bronchology Interv Pulmonol. 2013 Apr; 20(2): 186-8
Venkatappa N, Fadul R, Raymond D, Cicenia J, Gildea TR

Bronchopleural fistula (BPF) is an abnormal communication between the bronchus and the pleural space, commonly occurring after pulmonary resection or due to a spontaneous pneumothorax secondary to an underlying lung disease. We present a case of BPF in the setting of granulomatous polyangitis treated with endobronchial valves (EBV) with a longitudinal follow-up. These 1-way valves allow air and mucus to exit the diseased segment of lung during expiration, but prevent the reentry of air upon inspiration. The targeted segment may undergo atelectasis, achieving nonsurgical lung volume reduction, and allowing the remaining lung to compensate for the loss of volume. The use of these valves has shown to decrease hospitalization, morbidity, and mortality in these patients. In this case, the patient endured a prolonged hospitalization (82 d) and was able to be discharged only 7 days after EBV placement. This facilitated engagement in a pulmonary rehabilitation program, increased physical activity, and ultimately resumption of normal activity for the patient. To our knowledge, this is the first case of EBV used to treat BPF in the setting of underlying granulomatous polyangitis. This underscores the point that in appropriate settings, EBVs can decrease morbidity and mortality, and significantly improve the quality of life. HubMed – rehab


Fragment reattachment of fractured anterior teeth in a young patient with a 1.5-year follow-up.

BMJ Case Rep. 2013; 2013:
Ninawe N, Doifode D, Khandelwal V, Nayak PA

Crown fracture of maxillary anterior teeth is relatively common among children and teenagers. Aesthetic rehabilitation of crown fractures of the maxillary anterior is one of the greatest challenges to the dentist. Reattachment of a fractured fragment to the remaining tooth can provide better and long-lasting aesthetics, improved function, a positive psychological response and is a faster and less-complicated procedure. This article presents a case of reattachment of anterior tooth with a coronal fracture involving enamel, dentin and pulp with a 1.5-year follow-up. HubMed – rehab


Masculinity lost: a systematic review of qualitative research on men with spinal cord injury.

Spinal Cord. 2013 Apr 23;
Nolan M

Study design:Systematic, thematic, narrative review of qualitative literature.Objectives:To systematically review qualitative research that explores the impact of spinal cord injury (SCI) on the gendered experience of men with SCI.Methods:A systematic search of databases and hand search of relevant journals to provide a thematic narrative review of articles, providing sufficient depth of information, relevant participant quotes and phenomenological insight into the gendered experience of men with SCI. Identified studies are summarised and common themes extracted and discussed in relation to relevant literature on masculinity, disability and health.Results:Eight papers, representing four separate studies met the review criteria for relevance and rigour. Three broad, overlapping themes describing the gendered experience of men with SCI were identified: ‘lost masculinity’, outlining the impact of SCI on traditional masculine identity, ‘fighting back’, describing the battle to regain and reclaim masculinity and integrate disability into a revised identity and ‘beyond hegemony’, referring to possibilities beyond adherence to traditional masculine scripts.Conclusion:This review demonstrates a lack of explicit focus on men as gendered beings within the available qualitative literature. The findings are consistent with the limited quantitative data, which indicates that grappling with altered gendered identity is a central feature of life for men with SCI. Masculine identity emerges in this review as vulnerable to the impact of SCI, and given the strong links identified between masculinity, rehabilitation and health, as an aspect of experience that warrants more attention than it has received.Spinal Cord advance online publication, 23 April 2013; doi:10.1038/sc.2013.22. HubMed – rehab