The American surgeon
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The American surgeon · Dec 1996
Splenic salvage in adults at a level II community hospital trauma center.
Recognition of the important role of the spleen within the immune system has prompted surgeons to regularly consider splenic preservation. We studied our experience at a Level II trauma center to determine whether this trend is reflected in our management. We reviewed 81 adult blunt trauma patients with splenic injury admitted between January 1988 and December 1993. ⋯ Splenorrhaphy is frequently discussed but infrequently performed. Splenectomy remains the most commonly performed operation for splenic injury in adults with blunt splenic trauma. Nonoperative management is the most common method of splenic salvage at the Level II community hospital trauma center.
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The objective was to review our experience in the presentation and management of patients with penetrating cardiac injuries, using physiologic and anatomic indices. The setting was a 400-bed Level I urban trauma center. A 6-year retrospective case study was undertaken. ⋯ Patients presenting in shock (PI, 10; revised trauma score, 7-10) appeared to have higher survival rates when compared to those patients with a normotensive presentation. Twenty-three per cent of patients admitted with a PI < or = 10 died despite reaching the operating room within a mean of 45 minutes. Although the majority of patients who reach the operating room survive, a significant number of (initially normotensive) patients die soon after cardiorrhaphy.
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The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis. Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. ⋯ Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders. The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.
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The American surgeon · Dec 1996
Clinical TrialChanges in oxygenation and compliance as related to body position in acute lung injury.
Body positioning during mechanical ventilation for acute lung injury has not been studied in a detailed manner. We evaluated the relationship between oxygenation, compliance, and body position during mechanical ventilation of patients with acute lung injury (ALI). ⋯ Data obtained in each position (after a 45-60 minute equilibration time) included static pulmonary compliance and partial pressure of oxygen from arterial blood gas sampling. Oxygenation is not improved and compliance is adversely affected by upright body positioning as compared to the supine position in patients receiving mechanical ventilation for ALI.
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The American surgeon · Dec 1996
Case ReportsPericardial tamponade and death from Hickman catheter perforation.
In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed. ⋯ Resuscitative efforts, including chest tube placement and pericardiocentesis, were unsuccessful. Autopsy findings included perforation of the superior vena cava, with extension of the catheter in the pericardial sac and associated effusion. Despite the low reported incidence of perforation during placement of central venous catheters, we recommend confirmation of placement by fluoroscopy and instillation of radiopaque dye because of the high mortality associated with this complication.