The American surgeon
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The American surgeon · Aug 2002
Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.
Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms. The mortality rate from this infection ranges from 0 to 67 per cent. ⋯ Our data do not reach statistical significance with regard to the use of triple-antibiotic therapy. However, we believe that it is an important part of the treatment regimen. The combination of aggressive surgical therapy and appropriate antibiotic coverage results in a reduction in mortality.
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The American surgeon · Aug 2002
Assessment of initial base deficit as a predictor of outcome: mechanism of injury does make a difference.
Initial base deficit in injured patients has been shown to predict the adequacy of resuscitation and outcome. The usefulness of base deficit as a predictor of outcome, however, may be dependent on the mechanism of injury. We conducted a retrospective review of the trauma registry, supplemented by chart review, of all trauma patients treated at a Level I trauma center from January 1995 through July 2001. ⋯ Mortality increased with successive increases in base deficit but was markedly lower for a given base deficit in those patients having sustained stab wounds and/or severe lacerations as compared with those with gunshot wounds or blunt trauma. The value of the base deficit as a predictor of outcome depends upon the mechanism of injury and appears most useful for patients sustaining gunshot wounds or blunt trauma. Future studies in patients with penetrating trauma using base deficit as a predictor of outcome should separate patients with gunshot wounds from those with stab wounds or lacerations.
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Approximately half of breast cancers occur in women 65 years or older. Some studies suggest that breast cancer may be a more indolent disease in this group of patients. Debate exists over the appropriate treatment of these women as they are significantly underrepresented in breast cancer research studies. ⋯ We conclude that patients treated with tamoxifen and radiation therapy had a significantly smaller risk of recurrences than those treated with lumpectomy only or those receiving radiation alone. This supports similar treatment patterns recommended for younger patients. Women over 65 years of age should be carefully evaluated for adjuvant therapy.
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The American surgeon · Aug 2002
Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study.
Blunt trauma to the pancreas is an uncommon injury, which can be difficult to diagnose. Most studies are multi-institutional, include both helical and axial CT, and report sensitivities of 40 to 67 per cent. We evaluated the efficacy of spiral CT for the diagnosis of blunt pancreatic injury in a single large-volume institution. ⋯ We conclude that CT scan is only moderately sensitive and can underestimate or miss pancreatic injury. Although CT moderately correlated with injury grade it was highly predictive for presence of injury. The new multidetector helical scanner may improve our diagnostic ability.
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The American surgeon · Aug 2002
Obturator bypass: a classic approach for the treatment of contemporary groin infection.
As the number of cardiac and interventional radiologic procedures has risen, the frequency with which surgeons are called to treat groin complications has increased. Infectious groin problems that often involve foreign prosthetic material or remnants of percutaneous femoral closure devices are particularly challenging and require control of bleeding, removal of foreign material, wide debridement, and sometimes arterial resection. Management of the consequential limb ischemia in such cases is controversial. ⋯ There were no late graft infections. We conclude that the obturator bypass is an effective and durable means of revascularization in the presence of the septic groin. This procedure belongs in the armamentarium of all surgeons managing these complications.