The American surgeon
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The American surgeon · Mar 1991
Bilaminate synthetic dressing for partial thickness burns. Lack of cost reduction for inpatient care.
Forty-nine cases of second degree burns initially treated as inpatients from April 1984 through December 1987 are reviewed. Thirty-four patients were treated with bilaminate synthetic dressing (Biobrane) application, while 15 were treated with a topical antimicrobial, usually silver sulfadiazine. The burns ranged from 1 to 25 per cent total body surface area and were comparable in both groups. ⋯ These burns were subsequently treated with topical antimicrobial agents and healed primarily. The mean total hospital stay for this group was 18.0 +/- 11.9 days with the costs being much higher secondary to the initial cost of the Biobrane, the costs associated with topical antibiotic therapy, and extended hospital stay. Although there was a decrease in nursing time and a subjective decrease in patient discomfort associated with using synthetic dressing, no benefit was found in either decreasing hospital stay or total cost of hospitalization and supplies used for inpatients treated at this institution.
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Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. ⋯ A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.