IntroductionRecent research has determined Glasgow Coma Scale (GCS) to be an independent predictor of mortality in patients with traumatic inferior vena cava (IVC) injuries. The aim of this study was to evaluate the use of GCS, as well as other factors previously described as determinants of mortality, in a cohort of patients presenting with traumatic IVC lesions.MethodsA 7-year retrospective review was undertaken of all trauma patients presenting to a tertiary care trauma center with trauma related IVC lesions. Factors described in the literature as associated with mortality were assessed with univariate analysis. ANOVA analysis of variance was used to compare means for continuous variables; dichotomous variables were assessed with Fischer’s exact test. Logistic regression was performed on significant variables to assess determinants of mortality.ResultsSixteen patients with traumatic IVC injuries were identified, from January 2005 to December 2011. Six patients died (mortality, 37.5%); the mechanism of injury was blunt in one case (6.2%) and penetrating in the 15 others (93.7%). Seven patients underwent thoracotomy in the operating room (OR) to obtain vascular control (43.7%). Upon univariate analysis, non-survivors were significantly more likely than survivors to have lower mean arterial pressures (MAP) in the emergency room (ER) (45.6 +/- 8.6 vs. 76.5 +/- 25.4, p = 0.013), a lower GCS (8.1 +/- 4.1 vs. 14 +/- 2.8, p = 0.004), more severe injuries (ISS 60.3 +/- 3.5 vs 28.7 +/- 22.9, p = 0.0006), have undergone thoracotomy (83.3% vs. 16.6%, p = 0.024), and have a shorter operative time (105 +/- 59.8 min vs 189 +/- 65.3 min, p = 0.022). Logistic regression analysis revealed GCS as a significant inverse determinant of mortality (OR = 0.6, 0.46-0.95, p = 0.026). Other determinants of mortality by logistic regression were thoracotomy (OR = 20, 1.4-282.4, p = 0.027), and caval ligation as operative management (OR = 45, 2.28-885.6, p = 0.012).ConclusionsGCS, the need to undergo thoracotomy, and caval ligation as operative management are significant predictors of mortality in patients with traumatic IVC injuries.

SummaryAcute appendicitis is a very common problem in well developed countries. There seems to be a dietary influence involved but this has not been proven. The most common cause of acute appendicitis is blockage of the inside of the appendix by a fecalith (stool or fecal stone). History and physical examination and blood work results are usually enough to correctly make the diagnosis. X-ray tests such as ultrasound, CT scans or MRI may help in confirming the diagnosis. The treatment of choice is surgical removal of the irritated appendix, which can be safely done by an open or a laparoscopic technique. AbstractAcute appendicitis is a very common disease where the appendix becomes blocked, and leads to irritation and infection. When the appendix becomes irritated the patient can feel belly pain. The belly pain is first felt near the belly button and after a while it can move to the right lower area of the belly. The pain may go along with a loss of wanting to eat, nausea and vomiting. Many things can block the appendix opening leading to loss of blood supply and appendicitis. This includes waste produced from the food we eat, inflamed lymph nodes around the appendix or a growth in the appendix. Treatment is usually surgery to remove the appendix (appendectomy) as well as antibiotics given through a vein. The diagnosis is usually made by talking to and examining the patient and checking with different types of tests. Surgery works well in most patients who have appendicitis. The risk of having a problem or complication is low. Surgery to remove the appendix may be safely done with an open technique with a larger incision (laparotomy) or using small incisions and a camera (laparoscopic). They both have small short term and long term risks.

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