The American surgeon
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The American surgeon · Sep 2005
Predictors of morbidity and mortality in patients with traumatic duodenal injuries.
The aim of our study is to determine factors that predict morbidity and mortality in patients with traumatic duodenal injury (DI). A retrospective review from July 1996 to March 2003 identified 52 patients admitted to our trauma center (age 24.4 +/- 2.1 years, ISS = 18.8 +/- 1.76). The mortality rate for patients with duodenal injury was 15.4 per cent (n = 8). ⋯ Univariate analysis demonstrated that nonsurvivors were older, more, hypotensive in the emergency department, had a more negative initial base deficit, had a lower initial arterial pH, and had a higher Injury Severity Score. Nonsurvivors were also more likely to have an associated inferior vena cava (IVC) injury. Multivariate regression analysis revealed age, initial lowest pH, and Glasgow Coma Score to be independent predictors of mortality, suggesting that the physiologic presentation of the patient is the most important factor in predicting mortality in patients with traumatic DIs.
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The American surgeon · Sep 2005
Use of recombinant factor VIIa for adjunctive hemorrhage control in trauma and surgical patients.
Recombinant factor VIIa (rFVIIa) has recently been described for patients with ongoing massive bleeding in a number of different clinical scenarios. A retrospective chart review was conducted at a public level I trauma center in order to describe the use of rFVIIa in trauma and surgical patients with massive bleeding despite surgical control. Fifteen trauma and general surgical patients underwent major operative procedures and developed coagulopathy requiring massive blood product transfusion. ⋯ A partial or complete hemostatic response to rFVIIa was noted in 12 of 15 patients. The number of blood products received after administration of rFVIIa was significantly reduced and the International Normalized Ratio (INR) decreased. Our experience demonstrates that rFVIIa may reduce or completely arrest coagulopathic bleeding in trauma and surgical patients after vascular control.
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Magnetic resonance imaging (MRI) has been shown to detect occult invasive breast cancers with a sensitivity of 97 per cent to 100 per cent. Mammography and ultrasonography does not accurately assess the extent of ductal carcinoma in situ (DCIS), which results in a high reoperation rate. Breast MRI can improve the surgical planning in women with DCIS, improving the adequacy of initial treatment while reducing reoperation. ⋯ MRI changed the surgical management to more appropriate therapy in 15 per cent of patients avoiding additional surgery, while 11 per cent underwent negative surgical interventions. Breast MRI is a sensitive diagnostic imaging tool in patients with DCIS. However, any suspicious finding should be biopsied before a definitive operation is planned.