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Abstract
Massive trauma remains the leading cause of mortality among people aged younger than 45 years. In this review, we discuss the initial care and diagnosis of trauma patients followed by a comparison of resuscitation strategies. We discuss various strategies including use of whole blood and component therapy, examine viscoelastic techniques for management of coagulopathy, and consider the benefits and limitations of the resuscitation strategies and consider a series of questions that will be important for researchers to answer to provide the best and most cost-effective therapy for severely injured patients.
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Affiliation(s)
- Carter M Galbraith
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 619 19th Street South, JT 845, Birmingham, AL 35249, USA
| | - Brant M Wagener
- Division of Critical Care Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA; Division of Molecular and Translational Biomedicine, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 901 19th Street South, PBMR 302, Birmingham, AL 35294, USA
| | - Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, Biopolis, Larisa 41500, Greece; Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Shahla Siddiqui
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, 12401 East 17th Avenue, 7th Floor, Aurora, CO 80045, USA.
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2
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Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg 2023; 94:455-460. [PMID: 36397206 DOI: 10.1097/ta.0000000000003794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Western Trauma Association (WTA) has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations, or scarcity of experience and cases. Blunt pancreatic trauma falls under one of these clinically complex and rare scenarios. This algorithm is the result of an extensive literature review and input from the WTA membership and WTA Algorithm Committee members. METHODS Multiple evidence-based guideline reviews, case reports, and expert opinion were compiled and reviewed. RESULTS The algorithm is attached with detailed explanation of each step, supported by data if available. CONCLUSION Blunt pancreatic trauma is rare and presents many treatment challenges.
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3
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Tamrat G, Kejela S. Delayed distal pancreatectomy for isolated complete pancreatic disruption secondary to “trivial” blunt abdominal injury: A case report and literature review. Clin Case Rep 2022; 10:e6295. [PMID: 36093448 PMCID: PMC9446079 DOI: 10.1002/ccr3.6295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Pancreatic injury is a formidable diagnostic and therapeutic challenge owing to its relative rarity. Most injuries are from motor vehicle related injuries in blunt trauma patients. We present a 22‐year‐old male patient presented after sustaining a kick to the abdomen. He developed progressive abdominal pain with vomiting with delayed generalization of the pain and involuntary guarding. On initial exploratory laparotomy, suction drainage was inserted, and patient underwent delayed spleen sparing distal pancreatectomy on the 25th post‐admission day. Patient had smooth postoperative course and was discharged on the 7th postoperative day.
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Affiliation(s)
- Girmaye Tamrat
- Department of Surgery College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | - Segni Kejela
- Department of Surgery College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
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4
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Al-Thani H, Ramzee AF, Al-Hassani A, Strandvik G, El-Menyar A. Traumatic Pancreatic Injury Presentation, Management, and Outcome: An Observational Retrospective Study From a Level 1 Trauma Center. Front Surg 2022; 8:771121. [PMID: 35155546 PMCID: PMC8831377 DOI: 10.3389/fsurg.2021.771121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BackgroundWe aimed to study the presentation, management, and outcomes of patients with a pancreatic traumatic injury.MethodsWe retrospectively analyzed data for all patients who were admitted with pancreatic injuries between 2011 and 2017 at the only level 1 trauma center in the country.ResultsThere were 71 patients admitted with pancreatic trauma (0.6% of trauma admissions and 3.4% of abdominal injury admissions) with a mean age of 31 years. Sixty-two patients had pancreatic injury grade I–II and nine had injury grade III–IV. Thirty-eight percent had Glasgow Coma Scale (GCS) <9 and 73% had injury Severity Score (ISS) >16. The level of pancreatic enzymes was significantly proportional to the grade of injury. Over half of patients required laparotomy, of them 12 patients had an intervention on the pancreas. Eight patients developed complications related to pancreatic injuries ranging from pancreatitis to pancreatico-cutaneous fistula while 35% developed hemorrhagic shock. Mortality was 31% and regardless of the grade of injury, the mortality was associated with high ISS, low GCS, and presence of hemorrhagic shock.ConclusionPancreatic injuries following blunt trauma are rare, and the injured subjects are usually young men. However, most injuries are of low-grade severity. This study shows that regardless of the pancreatic injury grade on-admission shock, higher ISS and lower GCS are associated with worse in-hospital outcomes. Non-operative management (NOM) may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ahmed Faidh Ramzee
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Gustav Strandvik
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- *Correspondence: Ayman El-Menyar
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Chien LC, Herr KD, Archer-Arroyo K, Vakil M, Hanna TN. Review of Multimodality Imaging of Renal Trauma. Radiol Clin North Am 2020; 58:965-979. [PMID: 32792127 DOI: 10.1016/j.rcl.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blunt trauma accounts for more than 95% of traumatic renal injury and results from shear forces from rapid acceleration or deceleration and/or collision against the spine or ribs. The use of multiphasic contrast-enhanced computed tomography (CT) has proven pivotal in the evaluation and management of traumatic kidney injury, and CT imaging features provide the basis for nonsurgical staging. This article describes the epidemiology and mechanisms of blunt and penetrating traumatic renal injury and reviews the range of findings from various imaging modalities, with a particular emphasis on contrast-enhanced CT.
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Affiliation(s)
- Ling-Chen Chien
- Department of Radiology and Imaging Sciences, Emory University, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308, USA
| | - Keith D Herr
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA.
| | - Krystal Archer-Arroyo
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/krystal_archer
| | - Mona Vakil
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/MonaVakil
| | - Tarek N Hanna
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/,ER_Rad_Hanna
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6
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Odedra D, Mellnick VM, Patlas MN. Imaging of Blunt Pancreatic Trauma: A Systematic Review. Can Assoc Radiol J 2020; 71:344-351. [PMID: 32063010 DOI: 10.1177/0846537119888383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. METHODS Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. RESULTS After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. CONCLUSION There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.
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Affiliation(s)
- Devang Odedra
- Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Vincent M Mellnick
- Abdominal Imaging Division, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
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7
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Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, Kim F, Peitzman AB, Fraga GP, Sartelli M, Ansaloni L, Augustin G, Kirkpatrick A, Abu-Zidan F, Wani I, Weber D, Pikoulis E, Larrea M, Arvieux C, Manchev V, Reva V, Coimbra R, Khokha V, Mefire AC, Ordonez C, Chiarugi M, Machado F, Sakakushev B, Matsumoto J, Maier R, di Carlo I, Catena F. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:54. [PMID: 31827593 PMCID: PMC6886230 DOI: 10.1186/s13017-019-0274-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | | | - Yoram Kluger
- Division of General Surgery Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Trauma Surgery Dept., Scripps Memorial Hospital, La Jolla, California USA
| | - Ari Leppaniemi
- General Surgery Dept., Mehilati Hospital, Helsinki, Finland
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Fernando Kim
- Urology Department, University of Colorado, Denver, USA
| | | | - Gustavo P. Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Martha Larrea
- General Surgery, “General Calixto García”, Habana Medicine University, Havana, Cuba
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mozir, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Via Paradisia, 56124 Pisa, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Paraguay
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Isidoro di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
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Muhammad A, Waheed AA, Alvi MI, Khan N, Sayani R. Interobserver Agreement on Focused Assessment with Sonography for Trauma in Blunt Abdominal Injury. Cureus 2018; 10:e2592. [PMID: 31501719 PMCID: PMC6726416 DOI: 10.7759/cureus.2592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Trauma constitutes a major public health problem. Ninty percent of world's fatalities on road occur in low and middle-income countries. Focused assessment with sonography in trauma (FAST) has a key role in trauma investigation, altering subsequent management in a significant number of patients. There is a rising trend of introducing FAST examination to non-radiologists and junior members of healthcare team to hasten triage of trauma patients. Objective To determine interobserver agreement on focused assessment with sonography for trauma in blunt abdominal injury between senior and junior residents. Methods This cross-sectional study was conducted at Aga Khan University Hospital. Three hundred patients with blunt abdominal trauma meeting inclusion criteria were enrolled. FAST was performed using standard curvilinear 3.5-5 MHz transducer. Agreement between junior and senior residents was measured and Kappa statistic was calculated. Results Mean age of the patients included in the study was 30.04 ± 18.09 years. Among these 237 (79%) were male and 63 (21%) were female. Sixteen (5.3%) were positive for intraperitoneal free fluid while the remaining 284 (94.7%) were negative. A total of 19 FAST examinations were reported positive by junior residents, of which 15 (78.9%) were confirmed by a senior resident to be correct, while four (21.05%) were falsely labeled positive by a junior resident. A total of 281 negative FAST examinations were reported by junior residents, of which 280 (99.6%) were confirmed by a senior resident, while only one (0.003%) was falsely labeled negative. Kappa statistic was calculated for inter-observer agreement on FAST examination findings, which showed a kappa value of 0.84 (very good agreement), with a p-value of <0.001. Conclusion Our study suggests very good interobserver agreement on FAST examination between senior and junior resident in patients with blunt trauma to the abdomen. Results suggest that FAST can be easily learnt with minimal radiology training and may have greater applicability in trauma.
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Affiliation(s)
| | - Adeel A Waheed
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | | | - Noman Khan
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | - Raza Sayani
- Department of Radiology, The Aga Khan University, Karachi, PAK
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Gulati M, Cheng J, Loo JT, Skalski M, Malhi H, Duddalwar V. Pictorial review: Renal ultrasound. Clin Imaging 2018; 51:133-154. [PMID: 29477809 DOI: 10.1016/j.clinimag.2018.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/25/2018] [Accepted: 02/14/2018] [Indexed: 02/06/2023]
Abstract
Ultrasound (US) is the first-line imaging modality for evaluating azotemic patients for urinary obstruction and renal size. US is also valuable for distinguishing congenital variants and simple cystic lesions from renal masses. Doppler US is effective in detection of renal calculi and evaluation of vascular pathology. Unfortunately, renal US is limited in distinguishing causes of medical renal disease. The kidneys have a complex internal architecture with a highly variable appearance on US. This article illustrates non-neoplastic renal conditions, including normal and embryological variants, parenchymal, cystic, and vascular diseases. Renal infections, calcifications, and trauma and fluid collections are also discussed, with an emphasis on distinguishing US features and pathophysiology.
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Affiliation(s)
- Mittul Gulati
- Department of Radiology, USC Keck School of Medicine, United States.
| | - Justin Cheng
- Department of Radiology, USC Keck School of Medicine, United States
| | - Jerry T Loo
- Department of Radiology, USC Keck School of Medicine, United States
| | - Matt Skalski
- Department of Radiology, Palmer College of Chiropractic, United States
| | - Harshawn Malhi
- Department of Radiology, USC Keck School of Medicine, United States
| | - Vinay Duddalwar
- Department of Radiology, USC Keck School of Medicine, United States
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10
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Abstract
The role of ultrasonography in diagnosing blunt renal trauma is uncertain because it is much less sensitive in detecting parenchymal organ injuries. Indirect evidence such as perinephric haematoma may be easier to identify by ultrasonography and it is highly suggestive of underlying renal parenchymal injury. A patient with significant renal injuries diagnosed by bedside ultrasonography is reported and the role of ultrasonography in renal trauma is discussed.
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11
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Wong E, Ngo ASY, Wee JCP, Lee JMH. Focused Assessment with Sonography in Trauma (FAST): Experience of a Tertiary Hospital in Southeast Asia. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791402100405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective This study compares the positive predictive value (PPV) and negative predictive value (NPV) of focused assessment with sonography in trauma (FAST) versus abdominal-pelvic computed tomography scans (CTAP) after blunt abdominal injury as well as the need for abdominal surgery. We also sought to determine if any false negative ultrasound studies were associated with significant morbidity. The results were compared with other studies. Design Retrospective cross-sectional study. Setting A tertiary hospital. Methods Cases were retrieved from the trauma registry and electronic medical records in a tertiary hospital in Singapore over a two year period from 1 January 2009 to 31 December 2010. Exclusion criteria included penetrating trauma and burns. The sonographic finding, computed tomography finding, and the outcome of the patients were retrieved. Diagnostic characteristics including predictive values were calculated. Results A total of 476 patients were enrolled. Four hundred fifty-nine patients had FAST performed with fifty (10.9%) being positive. Forty-nine patients (21.7%) out of 226 patients had CTAP which showed abnormalities and nineteen (4.0%) patients underwent surgery. Comparing FAST to detect abnormalities on CTAP, the PPV and NPV were 0.590 and 0.863 respectively. Comparing FAST with the need for surgery, the PPV and NPV were 0.280 and 0.990 respectively. Four patients (0.98%) had negative FAST but required surgery. There were no significant adverse outcomes or surgical intervention in patients with normal vital signs, normal initial physical examination and negative FAST findings but who did not have a CTAP. Conclusions In patients with an initial normal physical examination and negative FAST, emergent CTAP may be avoided. (Hong Kong j.emerg.med. 2014;21:230-236)
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Affiliation(s)
| | - ASY Ngo
- Jurong General Hospital, Department of Emergency Medicine, Singapore
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12
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Richards JR, McGahan JP. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. Radiology 2017; 283:30-48. [DOI: 10.1148/radiol.2017160107] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- John R. Richards
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
| | - John P. McGahan
- From the Departments of Emergency Medicine (J.R.R.) and Radiology (J.P.M.), University of California, Davis Medical Center, 4860 Y St, Sacramento, CA 95817
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13
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Affiliation(s)
- A N Smolyar
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - K T Agakhanova
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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14
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Coccolini F, Montori G, Catena F, Di Saverio S, Biffl W, Moore EE, Peitzman AB, Rizoli S, Tugnoli G, Sartelli M, Manfredi R, Ansaloni L. Liver trauma: WSES position paper. World J Emerg Surg 2015; 10:39. [PMID: 26309445 PMCID: PMC4548919 DOI: 10.1186/s13017-015-0030-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/24/2015] [Indexed: 01/13/2023] Open
Abstract
The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | | | | | | | - Andrew B Peitzman
- Surgery Department, University of Pittsburgh, Pittsburgh, Pensylvania USA
| | - Sandro Rizoli
- Trauma & Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Gregorio Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital, Bologna, Italy
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Roberto Manfredi
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
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15
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16
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Affiliation(s)
- A N Smolyar
- N.V. Sklifosovsky Research Institute of Emergency Care, Department of Health, Moscow
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17
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Lin Q, Lv F, Luo Y, Song Q, Xu Q, Su Y, Tang Y, Tang J. Contrast-enhanced ultrasound for evaluation of renal trauma during acute hemorrhagic shock: a canine model. J Med Ultrason (2001) 2014; 42:199-205. [PMID: 26576573 DOI: 10.1007/s10396-014-0601-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 10/09/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE Contrast-enhanced ultrasound (CEUS) is a highly specific and sensitive method for assessing hemodynamically stable patients with blunt abdominal trauma. We evaluated the efficacy of CEUS in assessing renal trauma in different states of hemodynamic instability or shock. METHODS Hemorrhagic renal lesions reflecting grade III-IV trauma were established in the kidneys of 25 mongrel dogs. Mild, moderate, and severe systemic hypotension was induced by controlled exsanguination. The features of renal trauma in CEUS and contrast-enhanced computed tomography (CECT) were assessed and compared before shock and during shock progression. RESULTS Gross pathology showed that with trauma, the kidneys gradually shrank and became soft, and the active bleeding in the area of the renal trauma gradually reduced and stopped. No significant differences were observed in the trauma detection rates between CEUS and CECT at any stage of shock. During the baseline and mild shock stage, sonograms obtained after intravenous injection of contrast agent showed marked contrast medium extravasation and pooling at the site of active bleeding. With shock progression, the difference in enhancement between trauma areas and the surrounding renal tissue decreased: the trauma areas became indistinct and the abnormal enhancement associated with active bleeding diminished. Further, CEUS enabled visualization of changes in renal perfusion associated with shock progression. Changes in contrast agent arrival time and the time to peaking were observed earliest in the mild shock model. The contrast agent peak intensity reduced, while the washout time increased as shock progressed from moderate to severe. CONCLUSION In our canine model, CEUS was found to be as accurate as CECT in assessing hemorrhagic renal lesions. Thus, CEUS seems a promising tool for monitoring hemodynamic changes and predicting early shock to enable the conservative treatment of severe renal trauma.
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Affiliation(s)
- Qian Lin
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Faqin Lv
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Yukun Luo
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Qing Song
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Qinghua Xu
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Yihua Su
- Department of Function, Tumor Hospital of Datong Coal Mine Group Limited Liability Company, 1 Xinsheng Rd, Datong, 037003, Shanxi, China
| | - Yu Tang
- Department of Ultrasound, 62th Hospital of Chinese People's Liberation Army, 3 Yushui Rd, Puer, 665000, Yunnan, China
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China.
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Singh K, Singh A, Vidyarthi SH, Garg M. Complete pancreatic transection associated with splenic injury resulting from blunt trauma. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2014. [DOI: 10.7713/ijms.2013.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Contrast-enhanced Ultrasound for Detection of Traumatic Splenic Bleeding in a Canine Model During Hemorrhagic Shock and Resuscitation. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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The use of contrast-enhanced ultrasound for the evaluation of solid abdominal organ injury in patients with blunt abdominal trauma. J Trauma Acute Care Surg 2013; 73:1100-5. [PMID: 22832765 DOI: 10.1097/ta.0b013e31825a74b5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The evaluation and management of blunt abdominal trauma is primarily nonoperative. Previous attempts to identify parenchymal solid-organ injury with sonography have been unsatisfactory. The use of Perflutren Lipid Microsphere (Definity) contrast-enhanced ultrasound (DUS) may provide an additional modality for evaluation of solid-organ injury with decreased risk of radiation exposure and contrast-related complications. METHODS Injured patients admitted to a state-designated Level I trauma center (January 2008 to July 2009), who showed evidence of solid-organ injury after blunt abdominal trauma on initial computed tomography (CT) were eligible for entry into the study. Patients underwent DUS examinations within 12 hours of initial CT. Ultrasound images were then compared with findings of CT for organ location, size, and grade of injury. RESULTS Twenty patients with evidence of solid-organ injury on CT were evaluated with DUS. DUS correctly identified five of eight liver lesions, with a sensitivity of 62.5%. DUS correctly identified all nine splenic lesions demonstrating a sensitivity of 100%. DUS correctly identified one of two kidney injuries, demonstrating a sensitivity of 50%. Overall, the positive predictive value for all solid-organ injuries was 100%, with negative predictive value of 20%. The overall sensitivity for DUS was 79% (15 of 19 patients), and specificity was 100% (15 of 15 patients). CONCLUSION Contrast-enhanced sonography is a potential new modality for the evaluation of solid-organ injury for patients with blunt abdominal trauma. With further research, DUS may provide a safe and accurate alternative to CT. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Screening ultrasonography of 2,204 patients with blunt abdominal trauma in the Wenchuan earthquake. J Trauma Acute Care Surg 2012; 73:890-4. [DOI: 10.1097/ta.0b013e318256dfe1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
Evaluation for splenic injury is an important component of patient assessment after blunt abdominal trauma. Key imaging modalities include ultrasound, particularly for rapid identification of hemoperitoneum, and computed tomography (CT), which permits a more detailed and accurate determination of splenic integrity. Specific findings at contrast-enhanced multidetector CT (MDCT) should prompt the consideration of catheter angiography with arterial embolization as an adjunct to nonsurgical management. This article reviews the roles of imaging in the management of splenic trauma, illustrates the MDCT appearance of various splenic injuries, and discusses imaging-based indications for operative and angiographic intervention.
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Tsai MT, Sun JT, Tsai KC, Lien WC. Isolated traumatic pancreatic rupture. Am J Emerg Med 2010; 28:745.e3-4. [PMID: 20637396 DOI: 10.1016/j.ajem.2009.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 10/19/2022] Open
Abstract
Traumatic pancreatic rupture is associated with high morbidity and mortality. The diagnosis is difficult and usually accompanied with other injuries. We reported a 17-year-old adolescent boy who experienced this disease alone. The diagnosis was first suspected in ultrasonography and then confirmed by computed tomography. Endoscopic retrograde pancreatography showed his pancreatic duct was patent. He made an uneventful recovery after 10 days of hospitalization. Ultrasonography is well known for detecting the presence of hemoperitoneum in blunt abdominal trauma. Furthermore, it can be applied to the assessment of patients with posttraumatic abdominal pain. It provides a real-time, noninvasive, and inexpensive means for screening this kind of patients.
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Affiliation(s)
- Ming-Tse Tsai
- Department of Emergency Medicine, Far Eastern Memorial Hospital, 20060 Taipei County, Taiwan
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Körner M, Linsenmaier U, Reiser M. [Mechanical obstruction as a cause of acute abdomen. Radiological differential diagnosis]. Radiologe 2010; 50:226, 228-36. [PMID: 20165939 DOI: 10.1007/s00117-009-1902-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mechanical obstruction is a common cause of acute abdomen. Besides the diagnosis of the obstruction itself it is crucial to recognize the cause of the obstruction for planning of conservative or operative treatment.This article gives a general overview of the methods available for imaging obstructions in the setting of an acute abdomen. In the second part the differential diagnoses of the most common causes of obstruction will be discussed.
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Affiliation(s)
- M Körner
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, München, Deutschland.
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25
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Sproviero J. The Role of Ultrasound in Penetrating Trauma. Eur J Trauma Emerg Surg 2009; 36:138-44. [DOI: 10.1007/s00068-009-9092-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 09/24/2009] [Indexed: 11/30/2022]
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Alonso RC, Nacenta SB, Martinez PD, Guerrero AS, Fuentes CG. Kidney in Danger: CT Findings of Blunt and Penetrating Renal Trauma. Radiographics 2009; 29:2033-53. [DOI: 10.1148/rg.297095071] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Pancreatic injuries are rare, with penetrating mechanisms being causative in majority of cases. They can create major diagnostic and therapeutic challenges and require multiple diagnostic modalities, including multislice high-definition computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, ultrasonography, and at times, surgery and direct visualization of the pancreas. Pancreatic trauma is frequently associated with duodenal and other severe vascular and visceral injuries. Mortality is high and usually related to the concomitant vascular injury. Surgical management of pancreatic and pancreatic-duodenal trauma is challenging, and multiple surgical approaches and techniques have been described, up to and including pancreatic damage control and later resection and reconstruction. Wide surgical drainage is a key to any surgical trauma technique and access for enteral nutrition, or occasionally parenteral nutrition, are important adjuncts. Morbidity associated with pancreatic trauma is high and can be quite severe. Treatment of pancreatic trauma-related complications often requires a combination of interventional, endoscopic, and surgical approaches.
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Affiliation(s)
- Stanislaw Peter Stawicki
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - C. William Schwab
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U. Current Role of Emergency US in Patients with Major Trauma. Radiographics 2008; 28:225-42. [PMID: 18203940 DOI: 10.1148/rg.281075047] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In patients with major trauma, focused abdominal ultrasonography (US) often is the initial imaging examination. US is readily available, requires minimal preparation time, and may be performed with mobile equipment that allows greater flexibility in patient positioning than is possible with other modalities. It also is effective in depicting abnormally large intraperitoneal collections of free fluid, which are indirect evidence of a solid organ injury that requires immediate surgery. However, because US has poor sensitivity for the detection of most solid organ injuries, an initial survey with US often is followed by a more thorough examination with multidetector computed tomography (CT). The initial US examination is generally performed with a FAST (focused assessment with sonography in trauma) protocol. Speed is important because if intraabdominal bleeding is present, the probability of death increases by about 1% for every 3 minutes that elapses before intervention. Typical sites of fluid accumulation in the presence of a solid organ injury are the Morison pouch (liver laceration), the pouch of Douglas (intraperitoneal rupture of the urinary bladder), and the splenorenal fossa (splenic and renal injuries). FAST may be used also to exclude injuries to the heart and pericardium but not those to the bowel, mesentery, and urinary bladder, a purpose for which multidetector CT is better suited. If there is time after the initial FAST survey, the US examination may be extended to extra-abdominal regions to rule out pneumothorax or to guide endotracheal intubation, vascular puncture, or other interventional procedures.
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Affiliation(s)
- Markus Körner
- Department of Clinical Radiology, University Hospital Munich, Nussbaumstr 20, 80336 Munich, Germany.
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Jain S, Telang P, Joshi M, Prabhakar S. Isolated pancreatic injury following blunt abdominal trauma in a child. Indian J Crit Care Med 2007. [DOI: 10.4103/0972-5229.33393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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30
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Sparano A, Acampora C, di Nuzzo L, Liguori P, Farina R, Scaglione M, Romano L. Color power Doppler US and contrast-enhanced US features of abdominal solid organ injuries. Emerg Radiol 2006; 12:216-22. [PMID: 16741757 DOI: 10.1007/s10140-006-0470-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/16/2005] [Indexed: 12/26/2022]
Abstract
Utilization of color power Doppler and sonographic contrast agents to basic ultrasound (US) further improve the detection and characterization of abdominal injuries, increasing the diagnostic accuracy and value of US as an important technique in the evaluation of the abdominal trauma. This paper provides an illustrated summary of our clinical experience with color power Doppler US (CD-US) and contrast-enhanced US (CE-US) in the evaluation of abdominal solid organ injuries, involving 32 documented cases over a 2-year period. The findings of the CD-US and CE-US were compared with those provided by state-of-the-art contrast-enhanced multidetector 16-row CT.
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Affiliation(s)
- Amelia Sparano
- Department of Radiology, Cardarelli Hospital, Via A. Cardarelli, 9-80131 Naples, Italy.
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