American journal of surgery
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A prospective study designed specifically to analyze errors in management and iatrogenic complications was conducted on 234 consecutive patients with penetrating chest trauma. Eleven percent of penetrating pleural injuries were incorrectly diagnosed on initial physical and radiologic examination, but this led to wrong management decisions in only 4 percent. Decisions regarding intercostal tube drainage were particularly inaccurate when emergency intubation was required prior to chest radiography. ⋯ Transdiaphragmatic injuries were initially missed in 5 of 14 patients. This resulted in management errors and delay in these patients. Awareness of atypical presentations and circumstances in which misjudgments and wrong decisions are prone to occur should help to avoid pitfalls and reduce mortality from penetrating chest trauma.
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We developed a standard reproducible test to determine surgical needle sharpness. This parameter was measured by recording the maximum force required to push a curved surgical needle through a thin laminated synthetic membrane. Three comparable groups of reversed cutting-edge needles were selected from different manufacturers for needle penetration testing. ⋯ The sharper needles had long, narrow cutting edge geometries compared with the short wide geometries of duller needles. The sharpest needles were fabricated from an American Society for Testing and Materials (ASTM) 45500 stainless steel alloy that has stronger tensile and yield strengths than those of ASTM 42000 and 42020 alloys used in the creation of the other needles. This stronger alloy allows the manufacturer to produce a longer, narrower cutting point geometry with reduced danger of either bending or breakage during surgery compared with needles made from weaker alloys (ASTM 42000 and ASTM 42020), which accounts for the superior sharpness of the Ethicon surgical needles.
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A retrospective study was carried out in nine children between the ages of 10 and 20 years with adenocarcinoma of the colon. No family history, significant medical history, or predisposing factors were identified, except for Turcot's syndrome in one child. Common presenting signs and symptoms were vague abdominal pain, nausea and vomiting, weight loss, change in bowel habits, and guaiac-positive stools. ⋯ Their median survival was 4 months compared with 24 months in the four patients diagnosed early. As with adults, the mainstay of therapy is operation. Our data indicate that an increased awareness and consideration of colon cancer in children will result in earlier diagnosis, a more favorable disease stage, and prolonged survival.
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Over a 9-year period, fasciotomy for presumed compartmental syndromes after trauma was performed in 25 upper extremities and 100 lower extremities in 122 patients. This procedure was most commonly indicated after vascular injuries in the lower extremities. Twenty percent of patients underwent fasciotomy before vascular repair. ⋯ Seventy-five percent of amputations in the lower extremities were related to a delay in performing fasciotomy or an incomplete fasciotomy. Upper-extremity fasciotomies most commonly did not decompress the deep component of the volar compartment, whereas lower extremity fasciotomies without fibulectomy most commonly decompressed all four below-knee compartments. Fasciotomy sites were closed by direct suture in more than half of the patients.
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The charts of 38 patients managed with a period of intensive medical treatment (mean 7 days) prior to portosystemic shunting were examined. We found that the operative delay did not improve the Child's class or the indices of liver function. The operative mortality rates in these patients were 0 in Child's A patients, 13 percent in Child's B patients, and 50 percent in Child's C patients. ⋯ The charts of 10 consecutive Child's C patients operated on without a period of intensive medical management (mean 3 days) were reviewed and compared with the charts of 8 Child's C patients with delayed operation. The two groups of patients were similar. We recommend that patients who need a shunt should be operated on as soon as possible after bleeding has ceased.