The American surgeon
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The American surgeon · Jan 2002
Comparative StudyPercutaneous dilatational tracheostomy is as safe as open tracheostomy.
Although percutaneous dilatational tracheostomy (PDT) has been advocated as an alternative to open tracheostomy (OT) its relative safety has been questioned repeatedly. This study prospectively compared the safety and complications of PDT and OT. Ninety-four patients underwent PDT and 252 patients underwent OT at this institution from December 1998 through April 2000 with the choice of procedure left to the operator. ⋯ Subcutaneous emphysema, soft-tissue infection, and a malpositioned tracheostomy tube were the remaining complications in the OT patients. We conclude that the complication rates of PDT and OT are comparable. The choice of PDT or OT should be dictated by the surgeon's training and experience, the patient's condition, neck anatomy, and stability for transfer to the operating room.
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The American surgeon · Jan 2002
Case ReportsStercoral perforation of the sigmoid colon: report of a rare case and its possible association with nonsteroidal anti-inflammatory drugs.
Stercoral perforation of the colon is a rare phenomenon with fewer than 90 cases reported in the literature to date. The pathogenesis of stercoral ulceration is thought to result from ischemic pressure necrosis of the bowel wall caused by a stercoraceous mass. Stercoral perforation in more than 90 per cent of cases involves the sigmoid or rectosigmoid colon with associated fecal mass causing localized mucosal ulceration and bowel wall thinning due to localized pressure effect. ⋯ Stercoral perforation is often a consequence of chronic constipation; however, there are other predisposing factors as the condition is rare compared with the frequency of severe constipation. One of the hypotheses includes the association of nonsteroidal anti-inflammatory drugs (NSAIDs) with stercoral perforation of the colon. Our case report lends support to this association with NSAID use; thus there need to be greater awareness and caution when using NSAIDs in chronically constipated patients.
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The abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intra-abdominal hypertension. ACS has been demonstrated to affect multiple organ systems including the cardiovascular, respiratory, gastrointestinal, genitourinary, and neurologic systems. To date most descriptions of ACS are found in the trauma literature, but the development of ACS in the general surgical population is being increasingly observed. ⋯ Surgical decompression of ACS significantly reduces peak inspiratory pressure while increasing urine output and cardiac index. The observed association between ACS and ischemic bowel may result from decreased mucosal perfusion as a direct result of abdominal hypertension. In our patient population ACS resulted in a 61.1 per cent mortality.
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The American surgeon · Jan 2002
The presenting chest roentgenogram in acute type A aortic dissection: a multidisciplinary study.
Acute type A aortic dissection requires early diagnosis and prompt surgical intervention. It is not entirely clear whether patients with this form of dissection have clear-cut chest roentgenogram (CXR) patterns or whether the CXR can guide the physician in directing further workup for acute aortic dissection. The purpose of this study is to evaluate the impact of the initial CXR in arousing suspicion for acute type A aortic dissection. ⋯ This data indicates that the presenting CXR is neither sensitive nor specific for acute type A dissection. In a patient with a suspicious history or physical examination, however, a CXR showing mediastinal widening or other aortic abnormalities should increase the suspicion for dissection and warrant further workup. Furthermore in a patient with a clinical suspicion a normal CXR reading should not delay echocardiography to rule out type A dissection.