The American surgeon
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The American surgeon · Apr 2009
Comparative StudyElderly patients with pelvic fracture: interventions and outcomes.
We examined the outcome of elderly trauma patients with pelvic fractures. Patients 65 years of age and older (elderly) with pelvic fractures were retrospectively compared with patients younger than 65 years with pelvic fractures and also with elderly patients without fracture. Over the study period, 1223 patients sustained a pelvic fracture (younger than 65 years, n=1066, 87.2%; elderly, n=157, 12.8%). ⋯ The elderly without fracture also had a higher mortality rate when compared with the younger patients (10.9% [191 of 1760]; P < 0.03). The elderly were more likely to die from multisystem organ failure (25.0% [eight of 32] vs. 10.2% [nine of 88]), whereas the nonelderly group was more likely to die from exsanguination (45.5% [40 of 88] younger than 65 years vs. 21.9% [seven of 32] 65 years or older; P < 0.05). Elderly patients with pelvic fracture have worse outcomes than their younger counterparts despite aggressive management at a Level I trauma center.
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The American surgeon · Apr 2009
Comparative StudyTransfusion, not just injury severity, leads to posttrauma infection: a matched cohort study.
Blood transfusion has been associated with infection; however, the collinearity of injury severity has not been clearly addressed to show a direct relationship. Using more rigorous analysis, we aimed to untangle the effect of injury severity from transfusion leading to sepsis. We hypothesized that blood transfusion independently increases infection in massively transfused versus nontransfused patients with matched Injury Severity Scores (ISSs). ⋯ Infection was most associated with transfusion of packed red blood cells (PRBCs), although transfusion of other blood products had strong collinearity with PRBCs. Transfused patients had eight times the risk of infection independent of ISS; this appears to be the result of PRBC transfusion. Modifying the ratio of components in transfusion protocols favoring plasma may cause less infection after injury.
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The American surgeon · Apr 2009
Comparative StudyAcute adrenal insufficiency may affect outcome in the trauma patient.
Acute adrenal insufficiency in the trauma patient is underrecognized and the impact poorly understood. Our hypothesis was that the identification and treatment of acute adrenal insufficiency reduces mortality in trauma patients. Institutional Review Board approval for the retrospective review of a prospective database from a Level 1 trauma center for 2002 to 2004 was obtained. ⋯ The 55 (40%) responders showed no statistical differences in outcome variables whether or not they received hydrocortisone. The untreated adrenal-insufficient patients had significantly higher mortality, longer hospital length of stay, intensive care unit days, and ventilator-free days. Conclusions were: (1) treatment of acute adrenal insufficiency reduces mortality by almost 50 per cent in the trauma patient; and (2) acute adrenal insufficiency recognized by low random cortisol levels or nonresponse to a stimulation tests should be considered for treatment.
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The American surgeon · Apr 2009
Comparative StudyPerineal injuries at a large urban trauma center: injury patterns and outcomes.
The purpose of this study was to describe the characteristics of this unique patient population, their clinical presentations, and outcomes. The Los Angeles County and University of Southern California Medical Center Trauma Registry was used to retrospectively identify patients who sustained perineal injuries. Information included gender, age, vital signs, trauma scores, mechanisms of injury, studies performed, surgeries performed, and outcomes. ⋯ Most patients with perineal injuries (93%) can be managed without colostomy. Associated injuries are not uncommon, particularly bony fractures. Mortality is mostly the result of exsanguination related to associated injuries.
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The American surgeon · Apr 2009
Case ReportsTreatment of hyperinsulinemic hypoglycemia due to diffuse nesidioblastosis in adults: a case report.
An 82-year-old man was admitted to our hospital with a complaint of hypoglycemic syncope in the early morning. Insulinoma was suspected, but an abdominal CT showed no mass. Abdominal angiography showed a slight stain fed from the splenic artery. ⋯ Because ASVS showed that the pancreatic body and tail had a lesion producing insulin abnormally, we performed a distal pancreatectomy to cure the hypoglycemia. Clinically, it is very difficult to distinguish diffuse nesidioblastosis from insulinoma. When we treat hyperinsulinemic hypoglycemia, ASVS can be an essential examination to decide the extent of pancreatectomy.