The American surgeon
-
The American surgeon · Jun 2003
Comparative StudyThe impact of pelvic and lower extremity fractures on the incidence of lower extremity deep vein thrombosis in high-risk trauma patients. Winner of the Best Paper Award from the Gold Medal Forum.
Lower extremity fractures (LEFx) and pelvic fractures (PFx) are believed to increase the risk of lower extremity deep vein thrombosis (LEDVT). We studied trauma patients at high risk for LEDVT to determine whether an increased incidence of LEDVT was associated with LEFx and/or PFx. From January 1995 through December 1997 4163 trauma patients were admitted to our Level I trauma center. ⋯ The power of this study to detect differences representing medium effect sizes was greater than 90 per cent. We conclude that LEFx and/or PFx was not associated with an increased incidence of LEDVT in trauma patients at high risk for LEDVT. Lower extremity venous duplex ultrasound needs to be performed in both Fx and NFx groups to detect LEDVTs.
-
Popliteal vascular trauma has historically been an urban phenomenon. We hypothesized that rural popliteal artery injury would result more often from blunt mechanisms of injury (MOI), have a longer time to operation, and result in a higher amputation rate. We retrospectively reviewed all cases of popliteal artery injury from December 1994 to May 2001 at our rural trauma center. ⋯ This is the first attempt to delineate the specific nature of rural popliteal artery trauma. The amputation rate was not different between the two different MOI and was independent of the time to operation. Of those patients receiving an amputation 83 per cent were transferred from another hospital and despite a statistically lower ISS still required an amputation.
-
The American surgeon · Jun 2003
Comparative StudyThe relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury.
The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. ⋯ Bivariate analysis revealed no ISS correlation with FIM-G (r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.
-
The American surgeon · Jun 2003
Case ReportsHepatic portal vein gas: clinical features and outcomes.
Hepatic portal vein gas (HPVG) is found as branching gas extending to near the periphery of the liver. Increased utilization of CT may identify HPVG in more patients. In the past HPVG was associated with acute abdomen and high mortality. ⋯ Physical examination and laboratory findings were not reliable indicators of intra-abdominal catastrophe. Furthermore CT scans are inaccurate for predicting the etiology of HPVG. Close observation may be appropriate in stable patients with HPVG without other specific findings.
-
This is a case presentation and discussion of a dialysis patient who presented to the surgical service with abdominal pain, hypotension, and tachycardia and in extremis who was found to have a contained retroperitoneal hematoma after rupture of his left kidney. Six months after an uneventful nephrectomy and postoperative recovery he again presented with hypotension and anemia and was found to have a contralateral retroperitoneal hematoma consistent with renal hemorrhage. After unsuccessful angioembolization, the patient underwent a right nephrectomy and recovered without sequelae. ⋯ Trauma is the most common cause of renal rupture, but other causes of spontaneous renal rupture are rare and include polyarteritis nodosa and urothelial carcinoma. The diagnosis of acute abdominal pain in the dialysis patient is a challenging differential. While a rare complication the diagnosis of spontaneous renal rupture should not be excluded in a patient presenting with abdominal pain, hypotension, and anemia.