The American surgeon
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The American surgeon · Sep 2001
The usefulness of serum troponin levels in evaluating cardiac injury.
The diagnosis and clinical significance of blunt cardiac injury remains controversial. Cardiac troponin I is not found in skeletal muscle and has a high sensitivity for myocardial ischemia or injury. We hypothesized that normal troponin levels 4 to 6 hours postinjury would effectively exclude the diagnosis of cardiac contusion. ⋯ An elevated troponin does not definitively diagnose a clinically significant contusion. However, these patients should be monitored at least for 24 hours. Patients suspicious for cardiac contusions who have normal troponins and no other serious injuries may be safely discharged to go home from the emergency department.
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We evaluated clinical factors that are predictive of pelvic X-ray findings. We sought to identify whether routine pelvic films are necessary in blunt trauma and addressed whether removal of these films would minimize cost. We performed a retrospective chart review of 111 patients without pelvic fractures and 108 with pelvic fractures seen at our Level 1 trauma center between August 1998 and September 1999. ⋯ The back and pelvic examinations were significantly associated with X-ray results (P < 0.001), and the potential savings with selective radiography was $168,300.00 per year. We believe that clinical factors identified in our study predict the need for pelvic X-ray. Because removal of these films would minimize cost we recommend the elimination of routine pelvic films for the awake and alert blunt trauma patient.
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The American surgeon · Sep 2001
Comparative StudyLaparoscopic ventral hernia repair reduces wound complications.
Postoperative wound complications can be a source of significant morbidity after open ventral hernia repair. By using smaller incisions a laparoscopic approach may decrease this complication. To determine the rate of wound complications after laparoscopic ventral hernia repair prospectively collected data on morbidity in 54 consecutive patients undergoing ventral hernia repair were analyzed. ⋯ Two-thirds of the major wound complications in the attempted laparoscopic group occurred in patients requiring conversion to an open procedure. Laparoscopic ventral hernia repair is a safe and effective alternative to conventional open ventral hernia repair. The main advantage of this minimally invasive approach is a decrease in the rate of major wound complications.
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The American surgeon · Sep 2001
Case ReportsA continuum between scapulothoracic dissociation and traumatic forequarter amputation: a review of the literature.
Both traumatic forequarter amputation and scapulothoracic dissociation are rare and life-threatening injuries. We present the case of a 31-year old woman who was ejected from a car after a motor vehicle accident and sustained an apparent partial forequarter amputation. ⋯ With both injuries mortality is high and prompt diagnosis and treatment imperative. By viewing scapulothoracic dissociation and forequarter amputation as a continuum faster recognition and appropriate treatment may be implemented for these devastating injuries.