The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Comparative StudyResection and primary anastomosis with proximal diversion instead of Hartmann's: evolving the management of diverticulitis using NSQIP data.
The emergency surgical treatment of acute diverticulitis with feculent or purulent peritonitis has traditionally been the Hartmann's procedure (HP). Debate continues over whether primary resection with anastomosis and proximal diversion may be performed in the setting of a high-risk anastomosis in complicated diverticular disease. In contrast to a loop ileostomy takedown, the morbidity of a Hartmann's reversal is preventative for many patients, leaving them with a permanent stoma. Our study compared the surgical outcomes of patients with perforated diverticulitis who underwent a HP to primary anastomosis with proximal diversion (PAPD). ⋯ The treatment of acute diverticulitis in the setting of contamination can be safely treated with resection, primary anastomosis, and proximal diversion as opposed to a HP in certain circumstances. Given the decreased morbidity of subsequent loop ileostomy takedown compared with a Hartmann's reversal, this procedure should be given consideration in the management of acute, perforated diverticulitis but may not be warranted in cases of feculent peritonitis.
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J Trauma Acute Care Surg · Apr 2012
Advanced endotracheal tube biofilm stage, not duration of intubation, is related to pneumonia.
Biofilms are complex communities of living bacteria surrounded by a protective glycocalyx. Biofilms have been implicated in the development of infections such as dental caries and hardware infections. Biofilms form on endotracheal tubes (ETT) and can impact airway resistance. The lifecycle of a biofilm has four stages. We hypothesize that there is a relationship between the stage of biofilm on the ETT and development of pneumonia. ⋯ Advanced biofilm stage (stage IV) is associated with pneumonia. Duration of intubation does not predict biofilm stage.
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J Trauma Acute Care Surg · Apr 2012
Clinical TrialSurgical treatment of transverse patella fractures by the cable pin system with a minimally invasive technique.
Transverse patella fractures are the most common type of patella fractures. Minimally invasive surgical technique for treatment of transverse patella fractures with the Cable Pin System has not been previously reported. ⋯ Surgical treatment of transverse patella fractures by the Cable Pin System with a minimally invasive technique was shown to provide satisfactory clinical results and excellent knee functions, with less pain and low incidence of complications. It could be a new option for treatment of transverse patella fractures.
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J Trauma Acute Care Surg · Apr 2012
Comparative StudyBase deficit as a marker of survival after traumatic injury: consistent across changing patient populations and resuscitation paradigms.
Damage control resuscitation (DCR) has improved outcomes in severely injured patients. In civilian centers, massive transfusion protocols (MTPs) represent the most formal application of DCR principles, ensuring early, accurate delivery of high fixed ratios of blood components. Recent data suggest that DCR may also help address early trauma-induced coagulopathy. Finally, base deficit (BD) is a long-recognized and simple early prognostic marker of survival after injury. ⋯ Despite limited adoption of formal DCR, overall survival after injury, stratified by BD, is identical in the modern era. Patients with severely deranged physiology, however, experience better outcomes. BD remains a consistent predictor of mortality after traumatic injury. Predicted survival depends more on the energy level of the injury (stab wound vs. nonstab wound) than the mechanism of injury (blunt vs. penetrating).
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J Trauma Acute Care Surg · Apr 2012
Determination of efficacy of novel modified chitosan sponge dressing in a lethal arterial injury model in swine.
Chitosan is a functional biopolymer that has been widely used as a hemostat. Recently, its efficacy has been questioned due to clinical failures as a result of poor adhesiveness. The purpose of this study was to compare, in a severe groin injury model in swine, the hemostatic properties of an unmodified standard chitosan sponge with standard gauze dressing and a novel hydrophobically modified (hm) chitosan sponge. Previous studies have demonstrated that hm-chitosan provides greatly enhanced cellular adhesion and hemostatic effect via noncovalent insertion of hydrophobic pendant groups into cell membranes. ⋯ Hm-chitosan is superior to unmodified chitosan sponges (p < 0.001) or standard gauze for controlling bleeding from a lethal arterial injury. The hm-chitosan technology may provide an advantage over native chitosan-based dressings for control of active hemorrhage.