American journal of surgery
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A 4 year experience with 245 patients with isolated lower thoracic or anterior abdominal gunshot wounds was reviewed. Twenty-three (16 percent) of the 144 abdominal injuries were clinically superficial and all were managed successfully nonoperatively. Of the remaining 121 patients, 115 were confirmed to have peritoneal violation at laparotomy and 111 (96 percent) of these had significant visceral injuries. ⋯ Twenty-six (17 percent) of the 156 patients with intraperitoneal trauma had unimpressive physical signs on admission. these findings support a policy of routine exploration for gunshot wounds violating the peritoneum. When depth of penetration is uncertain, diagnostic peritoneal lavage should be used. Only those patients with unequivocally superficial injuries warrant observation.
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The records of 84 patients in whom 98 Hickman-Broviac catheters were inserted were reviewed. The most common indication for catheter insertion was for administration of parenteral nutrition. Forty-four patients (52 percent) had catheters inserted for chemotherapy or combined chemotherapy and parenteranal nutrition. ⋯ The catheter-related sepsis rate was 8/6,308 catheter-days. These rates compare favorably with those reported by other investigators. Any patient with potential vascular access difficulty or obliterated or thrombosed veins who requires parenteral medication should be considered a candidate for insertion of a Hickman or Broviac catheter.
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A 5 year experience of 248 patients with isolated penetrating lower chest injury was reviewed. Twenty-two (15 percent) of the stab wounds and 46 (46 percent) of the gunshot wounds caused associated intraabdominal injury. Among those taken to the operating room for laparotomy, physical examination proved misleading in 40 percent of the patients with stab wounds and 30 percent of those with gunshot wounds. ⋯ The morbidity was high in patients with combined injuries, with major complications occurring in 27 percent of those with stab wounds and 43 percent of those with gunshot wounds. Two thirds or more of these complications were thoracic. There was one death (4 percent) among the patients with thoracoabdominal stab wounds and six (13 percent) among those with gunshot wounds.