American journal of surgery
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Twenty-seven blunt trauma patients with open pelvic fracture who were seen in a trauma center over a 10-year period were characterized for treatment and resource consumption. Age, injury severity score, mortality, mechanism of injury, associated injuries, blood requirement, length of stay (LOS), surgical procedures, and complications were analyzed. ⋯ Aggressive hemorrhage and sepsis control, including 2 hemipelvectomies, resulted in an overall survival rate of 85%, with no mortality occurring in the last 20 patients. The reduced mortality obtained in the treatment of this highly resource consumptive injury suggests that open pelvic fracture should be managed at a trauma center, where these resources are immediately available.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Role of octreotide in the prevention of postoperative complications following pancreatic resection.
Though morbidity and mortality rates following pancreatic resection have improved in recent years, they are still around 35% and 5%, respectively. Typical complications, such as pancreatic fistula, abscess, and subsequent sepsis, are chiefly associated with exocrine pancreatic secretion. In order to clarify whether the perioperative inhibition of exocrine pancreatic secretion prevents complications, we assessed the efficacy of octreotide, a long-acting somatostatin analogue. ⋯ In the patients in the high-risk stratum, complications were observed in 26 of the 68 (38%) patients treated with octreotide and in 46 of 71 (65%) patients given placebo (p less than 0.01). Whereas in patients in the low-risk stratum, the complication rate was 25% (14 of 57 patients) in those treated with octreotide and 42% (21 of 50 patients) in patients given placebo (p = NS). The perioperative application of octreotide reduces the occurrence of typical postoperative complications after pancreatic resection, particularly in patients with tumors.
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Patients with cardiopulmonary insufficiency undergoing laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum may retain CO2 resulting in clinically significant respiratory acidosis. A canine model of pulmonary emphysema induced by papain inhalation was utilized to evaluate the respiratory effects of both CO2 and helium pneumoperitoneum. Prior to papain inhalation and 5 and 8 weeks after initial treatment under general anesthesia, mechanical ventilation was adjusted to maintain the end-tidal CO2 (ETCO2) at 40 mm Hg during baseline and pneumoperitoneum physiologic monitoring periods. ⋯ In this canine model, all dogs demonstrated consistent hypercarbia during CO2 pneumoperitoneum prior to papain treatments, but CO2 retention was significantly increased in the emphysematous state. The occurrence of hypercarbia during CO2 pneumoperitoneum may be underestimated by ETCO2 monitoring as was revealed by an increased PaCO2 (arterial carbon dioxide pressure)-ETCO2 gradient with an increasing time interval between papain exposure and period of physiologic monitoring. Irrespective of the pulmonary condition of the dog, helium pneumoperitoneum did not produce any hypercarbic or acidic changes when compared with the concomitant baseline period of dogs prior to the induction of pneumoperitoneum, thus suggesting that helium pneumoperitoneum may be a reasonable alternative in patients at risk for CO2 retention.
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Elective repair of simple (uncomplicated) inguinal and femoral hernias avoids incarceration and bowel obstruction (complicated presentations). To identify factors that perturb this strategy, we analyzed the records of 1,859 consecutive nonpediatric patients with groin hernias. Incarceration or bowel obstruction prompted operation in 22 of 77 (29%) women and in 15 of 34 (44%) patients with femoral hernia. ⋯ Complicated presentations of groin hernias are associated with a higher proportion of women and patients with femoral hernias. Gangrenous bowel was encountered only in those patients with groin hernia and bowel obstruction. Early diagnosis and elective repair of uncomplicated hernias should remain our strategy in patients of all ages.
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In a 12-year period, 188 patients with penetrating wounds to the anterior neck were managed selectively. The 69 symptomatic patients were explored promptly. The remaining 119 patients (63%) were observed in the hospital using ancillary diagnostic tests based on injury location and trajectory. ⋯ In the observed group, one patient (0.8%) required delayed exploration for an occult injury. Average hospital stay for patients after neck exploration was 8.4 days, for patients after negative exploration 4.2 days, and for patients after observation 1.7 days. This ongoing experience confirms the efficacy and safety of selective neck exploration in a Level I Trauma Center.