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J Carel Goslings

Publications and source records attributed to J Carel Goslings.

5 recordsLinked to original sources
PubMed2006

Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multicenter analysis of 28 cases in The Netherlands.

BACKGROUND: Minimally invasive endovascular treatment of a traumatic rupture of the thoracic aorta is a new strategy in the care of multitrauma patients. We report the experience in The Netherlands with endovascular management of patients with acute traumatic ruptures of the thoracic aorta. METHODS: We reviewed 28 patients with a traumatic thoracic aortic rupture treated with a thoracic aortic endograft between June 2000 and April 2004. All patients underwent treatment at one of the four participating level 1 trauma centers. Data collected included age, sex, injury severity score, type of endovascular graft, endovascular operation time, length of stay, length of stay in the intensive care unit, and mortality. Follow-up data consisted of computed tomographic angiography and plain chest radiographs at regular intervals. RESULTS: All patients (mean age, 40.9 years; SD, 18.5 years) experienced severe traumatic injury, and the mean injury severity score was 37.1 (SD, 7.8). All endovascular procedures were technically successful, and the median operating time for the endovascular procedure was 58 minutes (interquartile range, 47-88 minutes). The overall hospital mortality was 14.3% (n = 4), and all deaths were unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during a median follow-up of 26.5 months (interquartile range, 10-34.6 months). Postoperative data showed no severe endovascular graft- or procedure-related morbidity, except for one patient with an asymptomatic collapse of the endovascular graft during regular follow-up. This was corrected by placing a second graft. CONCLUSIONS: This study shows that the results of immediate endovascular repair of a traumatic aortic rupture are at least equal to those of conventional open surgical repair. Especially in these multitrauma patients with traumatic ruptures of the thoracic aorta, endovascular therapy seems to be preferable to conventional open surgical repair.

Aorta, Thoracic↗
PubMed2006

Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results.

BACKGROUND: The ilioinguinal approach is well established for the treatment of pelvic fractures. As an alternative, the modified Stoppa approach can be used to expose pelvic and acetabular fractures. We describe our experience with this approach in patients with pelvic and acetabular fractures with respect to fracture reduction, technical aspects, and the incidence of intra- and postoperative complications. METHODS: This retrospective study describes a series of 25 consecutive patients where a modified Stoppa approach was used for pelvic or acetabular fracture fixation. RESULTS: Fifteen patients with acetabular fractures, six patients with a pelvic ring injury not involving the acetabular joint and four patients with a combined fracture were operated through a Stoppa approach. Nine patients had a total of 13 complications, none of which required reoperation. Anatomic or satisfactory reduction was achieved in 95% of the acetabular fractures. Pelvic ring fractures had an anatomic (displacement <1 cm) postoperative result in all 10 cases. CONCLUSION: The modified Stoppa approach allows an adequate exposure and good postoperative results for treatment of pelvic ring fractures and acetabular fractures that are eligible for an anterior approach.

Acetabulum↗
PubMed2006

Trauma surgery in the era of nonoperative management: the Dutch model.

BACKGROUND: Falling operative experience and diminished job satisfaction of trauma surgeons appears to be in part the result of nonoperative management of many blunt injuries. In The Netherlands, the responsibility of trauma surgeons includes the operative treatment of most pelvic and extremity injures, as well as the overall coordination of care. This study describes the type and number of operative procedures performed by a group of trauma surgeons at a trauma center in Amsterdam, The Netherlands. METHODS: The study was conducted in a university Level I trauma center with 1,250 annual trauma admissions (90% blunt trauma), of which 125 had an Injury Severity Score of 16 or above. During a 3-year period (2001-2003), all operative interventions performed by or under direct supervision of the trauma surgeons were retrospectively analyzed and categorized into eight groups. RESULTS: During the 3-year period, 2,011 operations were performed by the trauma surgeon group. Of these, 1,459 were single procedures and 552 were multiple interventions leading to a total of 2,784 procedures. Nonurgent procedures (n = 915) constituted 45% of the operations, whereas acute procedures (n = 1,096) accounted for 55% of the operations. Of the acute operations, almost 60% were performed during office hours; the remaining operations were performed outside office hours (evening 37%, night 13%, weekend 50%). CONCLUSION: This study shows that the addition of (non)operative fracture care results in a viable mix of surgical and nonsurgical management. This leads to broad skills and could enhance job satisfaction. These data could be of interest for the current discussion on the future of trauma surgery in North America and might give a lead to increase the attractiveness of our profession for future trauma surgeons.

Diagnosis-Related Groups↗