The American surgeon
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The American surgeon · Sep 2000
Comparative StudyIntensive care unit outcomes of surgical centenarians: the "oldest old" of the new millennium.
This study compared the severity of illness and outcomes of surgical intensive care unit (SICU) patients age 100 years or older with those of younger SICU patients. Severity of illness was measured with the Simplified Acute Physiology Score (SAPS) and the Quantified Therapeutic Intervention Scoring System (QTISS). Outcomes were evaluated with SICU length of stay (LOS), hospital LOS, SICU mortality, and hospital mortality. ⋯ SICU and hospital LOS were not significantly longer for centenarians. Mortality in the SICU and hospital was significantly different across the age groups and rose with age. However, the modest 11.1 per cent SICU mortality rate in centenarians along with their LOS statistics indicate that these patients fare relatively well in surgical intensive care.
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The American surgeon · Sep 2000
Extracorporeal membrane oxygenation for cardiac support in pediatric patients.
Extracorporeal membrane oxygenation (ECMO) has been used for pediatric cardiac support in settings of expected mortality due to severe myocardial dysfunction. We reviewed the records of 34 children (<18 years) placed on ECMO between March 1995 and May 1999. Demographic, cardiac, noncardiac, and outcome variables were recorded. ⋯ Mediastinal bleeding and renal failure were associated with poor outcome. Recovery of cardiac function occurred within the first week of ECMO support if at all. Longer support did not result in survival without transplantation.
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The American surgeon · Sep 2000
Retroperitoneal soft-tissue sarcomas: prognosis and treatment of primary and recurrent disease.
Soft-tissue sarcomas of the retroperitoneum constitute a heterogeneous group of tumors with varying histology, potential for complete resection, and propensity for recurrent disease-making the development of effective treatment difficult and challenging. A retrospective review of 23 patients with retroperitoneal sarcomas from 1985 through 1998 was performed to assess the biological behavior and clinical outcomes and to identify factors that may influence prognosis and optimize treatment strategy. Liposarcomas were the most common pathology (61%); 79 per cent of these were of low grade. ⋯ Three patients had as many as three operations for recurrent disease. With subsequent recurrences there was a decrease in interval from approximately 4 years to 2 years, and 33 per cent of these patients developed tumor dedifferentiation to high grade. An aggressive surgical approach with reoperation can produce prolonged survival in patients with low-grade retroperitoneal sarcoma.
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The American surgeon · Sep 2000
Comparative StudyBlunt chest trauma in the elderly patient: how cardiopulmonary disease affects outcome.
Blunt trauma patients with rib fractures have significant risk of morbidity and mortality. The risk of complications increases with age and cardiopulmonary disease. We reviewed our experience at a community hospital Level II trauma center over a 5-year period. ⋯ The CPD+ patients had longer hospitalization than the CPD- patients: 8.5 versus 4.3 days (P < 0.05). We conclude that elderly patients with multiple rib fractures and cardiopulmonary disease are at significant risk for complications that result in readmission to the hospital and intensive care unit and prolonged length of hospitalization. Admission to the intensive care unit with attention to cardiac and pulmonary status upon transfer to the ward is warranted.
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The American surgeon · Sep 2000
Endoscopic ultrasound does not accurately assess pathologic stage of esophageal cancer after neoadjuvant chemoradiotherapy.
The accuracy of endoscopic ultrasound (EUS) for initial staging of esophageal cancer is widely accepted. There is, however, considerable variability in the reported accuracy of EUS for restaging of esophageal neoplasms after neoadjuvant therapy. From June 1995 through December 1999, we prospectively studied a series of 26 patients who underwent neoadjuvant treatment for esophageal cancer and were subsequently restaged by EUS before resection. ⋯ Patients with a complete pathologic response were staged as T4N1 (one patient), T3N1 (three patients), T3N0 (one patient), and T2N1 (two patients). EUS cannot distinguish tumor involvement of the esophageal wall and lymph nodes from the postinflammatory changes that characterize effective neoadjuvant treatment. EUS is of limited utility in guiding clinical decision making after neoadjuvant therapy.