The American surgeon
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The American surgeon · May 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialImpact an anatomical site on bacteriological and clinical outcome in the management of intra-abdominal infections.
The clinical and bacteriological results of treatment for 429 patients who had intra-abdominal infection were analyzed to determine whether the anatomical origin of peritonitis influenced outcome. All patients had received effective broad spectrum antimicrobial therapy and operation in four multicenter trials. The diagnoses of infection were categorized into three sites: upper gastrointestinal tract, complicated appendicitis, and lower gastrointestinal tract. ⋯ Mortality was related to recurrent intra-abdominal infection after an unsuccessful primary operation and a serum albumin less than 25 g/l. Clinical trails of antimicrobials for intra-abdominal infection should consider stratification of patients according to these three levels of alimentary tract perforation when the site is known preoperatively. Patients who have infection secondary to previous surgery or who are malnourished represent a higher risk group even with appropriate antibiotics.
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The American surgeon · May 1998
Comparative StudyComparison of liver function tests after hepatic lobectomy and hepatic wedge resection.
Prior studies have suggested that changes in liver function tests may vary with the postoperative time interval and may be related to the extent of hepatic resection. This study describes characteristic profiles in parenchymal liver enzymes and other serum liver function tests over a 4-week course comparing anatomic to nonanatomic hepatic resections. The records of 48 patients undergoing successful major hepatic resection during a 3-year period were retrospectively reviewed. ⋯ These laboratory profiles differ with the extent of hepatic resection. The profiles reflect changes in volume status, parenchymal liver destruction, transient hepatic insufficiency, and postoperative hepatic regeneration. However, except possibly for PT and bilirubin, the routine use of these tests is not recommended, given that the results do not alter clinical management.
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The American surgeon · May 1998
Blunt splenic trauma: characteristics of patients requiring urgent laparotomy.
In victims of blunt abdominal trauma, the spleen is the most common organ damaged, it is the most likely source of serious injury, and is associated with significant morbidity and mortality. The participants in this study were emergency department (ED) patients with splenic trauma determined via imaging study, surgical exploration, or autopsy. Patients were located using both the institution's trauma registry and discharge diagnoses (ICD-9 codes) involving splenic injury resulting from blunt trauma. ⋯ Complaints of pain resulting from traumatic injury and abdominal examination findings did not identify patients requiring urgent operative management. Hemodynamic instability, evidence of multiple injuries, abnormal laboratory parameters, and the requirement for blood transfusion in the ED identifies a patient population likely to require operative therapy of their splenic injury. Emergency physicians should consider early surgical consultation or urgent transfer to the regional trauma center in patients with these characteristics.
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The American surgeon · May 1998
Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study.
Necrotizing fasciitis is an aggressive soft-tissue infection that in the past has carried a significant mortality rate. One of the most important determinants of outcome is recognition of the disease process. This is followed by aggressive resuscitation measures and radical debridement at the initial operation to control the infectious spread at the outset. ⋯ Early recognition and expeditious initial wide excision and debridement along with appropriate antibiotic coverage and support of systemic effects of necrotizing fasciitis serve to decrease morbidity and mortality. We believe the above is an absolute necessity followed by frequent washing and minor debridement of the wound until granulating tissue is observed. This can then be followed by procedures to close/cover the surgical defect (i.e., split-thickness skin grafts or various coverage flaps).
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The American surgeon · May 1998
The prevalence and effect of alcohol and drug abuse on cohort-matched critically injured patients.
A prospective study was undertaken at a Level I trauma center to evaluate the prevalence of substance use among victims of major trauma, along with the impact on clinical outcome. Five hundred sixteen patients had urine toxicology and blood alcohol screens performed and correlated with pattern and severity of injury, hospital course, and outcome. Three hundred seventy-one patients (71%) screened positive for alcohol or drugs, or both. ⋯ Univariate analysis revealed patterns of alcohol/drug use varied among subgroups according to demographics (less use among patients older than 55 years, females and Asians; more drug use in blacks; more alcohol use in Hispanics), mechanism of injury (non-use in blunt trauma patients and use of both in penetrating trauma patients) and body region injured (non-use in head-injured patients). Septic complications and mortality were more correlative with severity of injury, but not with use or non-use of alcohol or drugs. We conclude that alcohol and drug use remains a major comorbid factor in major trauma, and that injury prevention efforts should include a strong focus on counseling regarding these lifestyle choices.