The American surgeon
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The American surgeon · Aug 2007
Scout anteroposterior and lateral CT scans as a screening test for thoracolumbar spine injury in blunt trauma.
Anteroposterior and lateral radiographs have traditionally been required to clear the thoracolumbar spine (TLS) after blunt trauma. The routine use of CT scans led to a pilot trial to determine if CT scout images can accurately evaluate the TLS after blunt trauma. The purpose of the study was to determine the sensitivity, specificity, positive and negative predictive values of CT scout images for the evaluation of the TLS. ⋯ Sensitivity was 92 per cent, specificity 100 per cent, positive predictive value 100 per cent, and negative predictive value 99 per cent. Scout CT images provide an accurate assessment of the TLS after blunt trauma. We are encouraged by the results and will continue to investigate to identify the criteria that allow scout CT images to safely replace anteroposterior and lateral radiographs in the evaluation of the TLS in blunt trauma.
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The American surgeon · Aug 2007
Case ReportsHandlebar injuries in children: should we raise the bar of suspicion?
Injury prevention strategies for child bicyclists have focused on helmet use to prevent head trauma. Handlebars are another source of injury. A retrospective review from 2005 identified 385 admissions to a Level 1 pediatric trauma center of which 23 (5.9%) were pedal cyclists. ⋯ Discordance exists between the apparently minor circumstances of handlebar trauma and the severity of injury sustained by bicyclists. Recognizing the mechanism of handlebar-related injuries and maintaining a high index of suspicion for visceral injuries aids in the diagnosis. The incidence of these injuries is underestimated due to insufficient documentation of the circumstances of injury events and a lack of applicable E-codes specific for handlebar injury.
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The American surgeon · Aug 2007
Complicated appendicitis--is the laparoscopic approach appropriate? A comparative study with the open approach: outcome in a community hospital setting.
Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. ⋯ The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.
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The American surgeon · Aug 2007
Early glucose normalization does not improve outcome in the critically ill trauma population.
Strict control of serum glucose in critically ill patients decreases morbidity and mortality. The objective of this study was to evaluate the effect of early normalization of glucose in our burn and trauma intensive care unit. From January 2002 to June 2005, 290 patients were admitted with serum glucose 150 mg/dL or greater and 319 patients with serum glucose less than 150 mg/dL. ⋯ The early normalization cohort was younger in mean age than the late group, but these 2 groups were similar in injury severity. Correspondingly, there was no difference in the rate of infection. Although hyperglycemia on admission appears to correlate with a worse outcome, early glucose normalization did not affect morbidity and mortality in our critically ill population.
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The American surgeon · Aug 2007
Case ReportsCecal epiploic appendagitis: a diagnostic and therapeutic dilemma.
Acute epiploic appendagitis (EA) is a rare and often misdiagnosed cause of acute abdominal pain. Though a benign and often self-limiting condition, EA's ability to mimic other disease processes makes it an important consideration in patients presenting with acute abdominal symptoms. Careful evaluation of abdominal CT scan findings is crucial in the accurate diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention. ⋯ The patient recovered uneventfully with resolving leukocytosis. We present a case of cecal epiploic appendagitis mimicking acute appendicitis and review the current literature on radiographic findings, diagnosis, and treatment of this often misdiagnosed condition. General surgeons should be aware of this self-limiting condition and consider this in the differential diagnosis.