American journal of surgery
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One hundred thirteen patients presented with gastrointestinal complications due to persimmon phytobezoars during a 3 year period. One hundred three patients had a history of persimmon ingestion. One hundred five patients had undergone previous gastric operation for duodenal ulcer, one patient underwent highly selective vagotomy, and seven patients had not undergone previous operation. ⋯ We conclude that the treatment of choice of intestinal obstruction due to persimmon phytobezoars is milking of the bezoar into the large bowel without enterotomy. Preoperative or operative endoscopy should be performed in patients presenting with complications of gastrointestinal phytobezoars. Patients who have undergone gastric operation should be warned against the risk of persimmon ingestion.
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A total of 54 patients with stage I and stage II squamous cell carcinoma of the oral cavity were reviewed as to treatment modality, adequacy of treatment, and site of failure. Surgery was employed as the sole initial treatment modality in 52 patients. Forty-three underwent primary tumor excision alone and 9 underwent elective neck dissection at the time of primary tumor excision. ⋯ A small group of patients who underwent elective neck dissection had a demonstrably high survival rate. These observations lend support to the call for elective neck dissection in patients with stage I and II oral cavity carcinoma but are not conclusive. Therapeutic decisions regarding elective treatment of the neck will continue to be made according to the best judgment and prejudices of the individual surgeon until a prospective, randomized multi-institutional study addressing this specific issue is undertaken.
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Triage of potentially injured patients to the appropriate trauma hospital was carried out using mechanism of injury as a triage criterion rather than physiologic changes (trauma score). Injury mechanism includes field evidence of high energy transfer, such as falls of more than 15 feet, automobile accidents with structural intrusion, extrication difficulties, passenger ejection, or death at the scene. ⋯ Methods of evaluation of overtriage and undertriage are presented, but accepted standards for these must be addressed in each trauma system. Injury mechanism as a primary trauma triage criterion is an acceptable means of identification of potential injury for transport to a trauma facility.
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Comparative Study
Accuracy and relationship of mechanisms of injury, trauma score, and injury severity score in identifying major trauma.
The accuracy of mechanism of injury criteria and trauma scores as triage criteria for identifying major trauma patients has been determined from the experience at one trauma center treating 2,500 patients over a 2 year period. Death of the other occupant of the same vehicle as the patient and patient extrication taking longer than 20 minutes were determined to be sufficiently accurate triage criteria. Trauma scores of 14 or less were more accurate than trauma scores of 12 or less.
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Considerable controversy still exists regarding the correct management of cancer of the breast. This short history follows the paths of thought and practice from the Egyptian dynasties to modern times. A description is given of the pathologic reasons for the variance in local treatment and the development of adjuvant therapy.