The American surgeon
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The American surgeon · Jul 2002
Blood transfusions correlate with infections in trauma patients in a dose-dependent manner.
Infections are a common and significant sequela of major traumatic injury. The objective of this study was to evaluate the relationship between infections in trauma patients and the transfusion of packed red blood cells (pRBCs) within the first 48 hours of admission. We hypothesized that transfusions of pRBCs were associated with an increased risk of infection in a dose-dependent manner. ⋯ In summary there is a clear dose-dependent correlation between transfusions of pRBCs and the development of infection in trauma patients. Multivariate analysis further demonstrated that pRBCs were an independent risk factor for the development of infections. Although transfusions are frequently indicated, they should be administered appropriately and with no more pRBCs than absolutely necessary.
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Prompt diagnosis of acute traumatic injury to the diaphragm remains a challenge when the admission chest X-ray is unrevealing and immediate laparotomy or thoracotomy is not indicated. Diagnostic delay may contribute to significant morbidity and mortality. A retrospective review of our 15-year experience with diaphragm injury (DI) revealed 13 patients (nine male/four female; mean age, 40 +/- 34 years) who sustained injuries to the left (77%) and right (23%) diaphragm respectively as a result of motor vehicle crashes (MVCs) (69%), penetrating trauma (30%), and pedestrian-versus-car accidents (1%). ⋯ She is scheduled for exploration in the near future. DI particulary after blunt trauma and on the right side may be missed in the absence of other indications for immediate surgery because radiographic abnormalities of the diaphragm particularly on the right are often attributed to thoracic pathology or may be absent initially. A high index of suspicion for DI may help lead to an earlier diagnosis especially when the patient's clinical condition fails to improve.
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The American surgeon · Jul 2002
Major lower-extremity amputation: contemporary experience in a single Veterans Affairs institution.
Our objective is to describe our current experience with major lower-extremity amputation secondary to vascular disease. We conducted a retrospective review of sequential amputations over a 3-year period at one Veterans Affairs institution. One hundred thirteen amputations were performed in 99 men (age 70 +/- 11 years). ⋯ One-year mortality is high. Low rehabilitation rates especially in dialysis patients mandate further efforts in this regard. Vigilant follow-up of the contralateral limb is essential.