American journal of surgery
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Computerized tomography has proved useful in the evaluation of selected patients suffering blunt abdominal trauma. Seventeen patients with major multisystem injuries were treated using a protocol involving abdominal computerized tomographic scans for evaluation of intraabdominal injury. ⋯ The remainder of the patients with intraabdominal solid organ injury diagnosed by computerized tomographic scan were followed under strict guidelines and recovered without surgery. Computerized tomography represents a quick, accurate diagnostic technique for dealing with blunt abdominal trauma in selected multiply injured patients.
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The data derived from 105 severe pelvic fractures have provided guidelines for managing paralytic ileus associated with fracture. Fracture types I, II, IV, and double type III can be treated expectantly with a high degree of confidence that ileus will resolve within 2 days. ⋯ However, should ileus in patients with diametric fractures continue longer than 5 days, parenteral nutrition should be started, since ileus will persist for an average of 2 weeks. A direct correlation between type of pelvic fracture, amount of retroperitoneal blood, loss and duration of ileus has been documented.
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A simplified radiographic procedure was utilized in children with suspected acute appendicitis in an effort to improve diagnostic accuracy. Children with suspected appendicitis were given 6 oz of barium by mouth, and follow-up posteroanterior, and oblique radiographs of the abdomen were obtained 6 to 12 hours after barium ingestion. Appendicitis was not seen in 63 children with complete appendiceal filling. ⋯ A 42 percent incidence of appendicitis was noted in 110 children with nonvisualization of the appendix, and an 86 percent incidence of appendicitis was noted where there was a mass effect on the cecum. The advantages and disadvantages of the barium swallow have been discussed. By utilizing the barium swallow as a diagnostic adjunct, an overall 95 percent accuracy rate in the diagnosis of acute appendicitis was achieved over a 4 1/2 year period.
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Results of our retrospective review of 100 consecutive patients show that early intramedullary nailing can be accomplished in severely injured patients without increasing the risk of fat embolism syndrome. No cases of fat embolism syndrome were seen after immediate (less than 24 hours) intramedullary nailing of femoral shaft fractures. ⋯ This is attributed to the greater severity of injury present in the patients selected for immediate intramedullary nailing (injury severity scores 23.2 in immediate group; 12.4 in delayed group). The incidence of critical hypoxemia in the immediate group was equivalent to that in another group of injured patients who did not have fractures, but who did have similar injury severity scores.
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Transcutaneous oxygen sensor values reflect peripheral oxygen tensions. During shock and resuscitation, transcutaneous oxygen sensor values depend on peripheral blood flow, and, therefore, reflect cardiac output and oxygen delivery. Transcutaneous oxygen sensor monitoring, therefore, should be quite useful when caring for acutely ill patients; data from 20 surgical emergency department patients support this hypothesis. ⋯ In addition, transcutaneous oxygen sensor was useful for continuous monitoring during resuscitation. Successful correction of hypoxia and perfusion deficits results in increased transcutaneous oxygen sensor values. Failure of the transcutaneous oxygen sensor value to increase during resuscitation implies ongoing deficits of tissue oxygenation.