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Biomedical subjects

Christine Gaarder

Publications and source records attributed to Christine Gaarder.

9 recordsLinked to original sources
PubMed2006

Nonoperative management of splenic injuries: improved results with angioembolization.

BACKGROUND: Nonoperative management (NOM) of patients with severe splenic injuries carries a significant risk of failure. We hypothesized that adding angiographic embolization (AE) to the NOM protocol would decrease the laparotomy rate, and increase the success rate of NOM and splenic salvage rate. METHODS: A protocol introducing AE in the treatment of splenic injuries was implemented. AE was performed in OIS splenic injury grades 3 to 5 and in all cases where signs of ongoing bleeding were encountered regardless of injury grade. Patients included in a prospective study during a 24-month period were compared with a historic control group. RESULTS: Group 1 (before AE) consisted of 69 patients with a mean Injury Severity Score (ISS) of 31, and group 2 (after introducing AE) included 64 patients with a mean ISS of 30. In group 1, 30 patients underwent immediate laparotomy (43%), and the NOM success rate was 79%. After introducing AE, 17 patients underwent immediate laparotomy (27%; p = 0.04), with a NOM success rate of 96% (p = 0.02). Overall splenic salvage rate increased from 57% to 75% (p = 0.02). Angiography was performed in 31 patients in group 2. Embolization was performed in 27 of these patients. AE failure rate was 4%. NOM was successful in 14 of 15 patients with OIS injury grades 4 and 5 after the introduction of AE (93%). CONCLUSION: A formal protocol adding mandatory AE to NOM for severe splenic injuries increased the percentage of patients in whom NOM was attempted, the NOM success rate, and the splenic salvage rate.

Adolescent↗
PubMed2005

[Treatment of splenic injuries in children].

BACKGROUND: Most children with blunt splenic trauma are treated non-operatively. Controversy exists regarding the minimal hospital stay, follow-up imaging and length of activity restriction required after discharge. MATERIAL AND METHODS: To evaluate outcome for this group of patients, a review was performed of children (age below 14) with blunt splenic injuries treated between January 2000 and December 2003. RESULTS: Fifteen children were admitted with blunt splenic trauma, all were successfully treated non-operatively. Four patients were excluded from further analysis because of multiple injuries that prolonged their hospital stay or they were transferred to our institution more than six days after the accident. Median age was 8 years (range, 1-12). Median length of stay was 5 days (range, 3-8) including 0 days (range, 0-4) in the intensive care unit. Median numbers of follow-up ultrasound examinations were 2 (range, 0-4) with no influence on treatment. Reduced activity after discharge was advised for a median of 4 weeks (3-6). All patients had an uneventful recovery. INTERPRETATION: Haemodynamically stable children with blunt splenic injuries can be treated non-operatively with short hospital stay and a few weeks of restricted activity after discharge. Routine follow-up imaging seems unnecessary.

Child↗
PubMed2005

The impact of patient volume on surgical trauma training in a Scandinavian trauma centre.

OBJECTIVE: Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma care. METHODS: Patients registered in the hospital based Trauma Registry during the 2-year period from 1 August 2000 to 31 July 2002 were included. RESULTS: Of a total of 1667 patients registered, 645 patients (39%) had an Injury Severity Score (ISS)>15. Abdominal injuries were diagnosed in 205 patients with a median ISS of 30. An average trauma team leader assessed a total of 119 trauma cases a year (46 patients with ISS>15) and participated in 10 trauma laparotomies. CONCLUSION: Although the total number of trauma cases seems adequate, the experience of the trauma team leaders with challenging abdominal injuries is limited. With increasing sub-specialisation and general surgery vanishing, fewer surgical specialties provide operative competence in dealing with complicated torso trauma. A system of additional education and quality assurance measures is a prerequisite of high quality, and has consequently been introduced in our institution.

Abdomen↗
PubMed2005

[Pseudoaneurysm in splenic injury].

Blunt splenic injuries are increasingly being managed non-operatively. Consequently, radiological examinations in the follow up of these injuries must aim at detecting lesions like pseudoaneurysms that can cause delayed bleeding. Two patients are presented. They were both diagnosed at a local hospital and treated at the regional trauma centre. In both patients pseudoaneurysms were detected on CT examination with arterial contrast phase. Angiographic embolisation was performed successfully. The cases are discussed with reference to relevant literature. Pseudoaneurysms may not be detected at the initial CT scan and can cause delayed bleeding. Thus it seems wise to perform a CT scan in arterial and venous contrast phase 5-7 days after the injury. Interventional angiography should be offered haemodynamically stable adult patients with serious splenic injury and in the absence of other indications for laparotomy.

Adolescent↗
PubMed2005

Advanced surgical trauma care training with a live porcine model.

OBJECTIVE: To evaluate the benefit of a compulsory operative trauma care course for general surgeons in Norway utilising a live porcine model. METHODS: The participants rated their expertise in 23 situations pre- and post-session on a scale 1-5, where 1 meant "not competent" and 5 meant "fully competent". RESULTS: Mean total score increased 43% from pre- to post-session. The increase reached significance with all levels of experience. Procedures rarely performed, like suturing on a beating heart, showed a greater educational benefit than more frequently performed procedures, like inserting a chest tube. CONCLUSION: The operative trauma care animal session increased the participants' perceived competence significantly. Its use seems justified for education in trauma related lifesaving surgical procedures.

Animals↗
PubMed2005

Nonoperative management of pediatric splenic injury with angiographic embolization.

A 12-year-old girl was admitted after a bicycle accident, and a grade 4 splenic injury was diagnosed. She became hemodynamically unstable within the first hours after arrival and remained so despite fluid resuscitation and transfusions. As an alternative to laparotomy, splenic artery embolization was performed. The patient had an uneventful recovery without the need for further transfusions. Nonoperative management of blunt splenic trauma remains the gold standard in pediatric trauma care. In hemodynamically unstable patients, splenic artery embolization should be considered as an adjunct to that strategy.

Angiography↗
PubMed2004

[Vacuum pack technique--a good method for temporal abdominal closure].

UNLABELLED: Abdominal compartment syndrome(ACS) is a clinical entity characterised by increased intraabdominal pressure leading to multiple organ failure, fatal if left untreated. The treatment of abdominal compartment syndrome is surgical decompression with a temporary abdominal wall substitute. To avoid the development of abdominal compartment syndrome, temporary abdominal closure (TAC) should be considered after celiotomy for trauma. A new method for TAC was introduced at Ullevaal University Hospital in 2002, the "vac pac". METHOD: The "vac pac" technique is described and the patients treated with "vac pac" during the first year after introduction are presented. RESULTS: Five patients were treated using the "vac pac". One patient had acute pancreatitis and developed abdominal compartment syndrome. The other patients were severely injured and the indication for TAC was abdominal compartment syndrome in one patient, intestinal oedema in another, and damage control surgery with packing in two patients. Delayed primary closure was achieved within five days in all our patients. There were no fatalities and no complications related to the use of "vac pac" were registered. CONCLUSION: The "vac pac" technique seems to be a good method for TAC.

Abdominal Injuries↗