The American surgeon
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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.
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The American surgeon · Apr 2009
Comparative StudyPatients with Cushing's syndrome are care-intensive even in the era of laparoscopic adrenalectomy.
We report outcomes from laparoscopic adrenalectomy (LA) comparing patients with Cushing's syndrome with those with other adrenal pathology with respect to length of stay (LOS), overall complications, and financial implications. We conducted a retrospective review of 80 continuous patients (103 glands) undergoing LA. The clinical diagnoses were: hypercortisolism (Cushing' syndrome; n=33), hyperaldosteronism (Conn's syndrome; n=20), phaeochromocytoma (n=16), and neoplasm (others; n=11). ⋯ LA in patients with Cushing's syndrome is associated with longer hospitalizations, more frequent major complications, and higher advanced care requirements, especially for patients undergoing bilateral adrenalectomy. Minor complications were infrequent and median LOS was brief regardless of diagnosis. Patients with Cushing's syndrome had higher costs for overall hospital charges, advanced care, and anesthesia.
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The American surgeon · Apr 2009
Roger T. Sherman Lecture. Advances in the management of blunt thoracic aortic injury: Parmley to the present.
This article traces the evolution in management of blunt aortic injury (BAI) over the past 50 years from the time of the seminal description from Parmley in 1958. There have been major advances in both diagnostics and treatment paradigms with very rapid technologic advances occurring over the past decade. For many years, conventional aortography was the principle diagnostic tool, but it has been replaced by the progression of CT. ⋯ Many patients with major associated injuries have definitive treatment of BAI managed in a delayed fashion with the use of hypertensives, which appears to improve outcomes. In the past 5 years, definitive treatment has changed with the majority of injuries being treated today with endoluminal stent grafts as opposed to open thoracotomy and traditional repair techniques. Paraplegia rates have diminished from 8 to 10 per cent down to 1 to 2 per cent in association with these therapeutic advances.
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Gunshot wounds to the head are associated with poor outcome. We reviewed data to identify prognostic factors. We performed a retrospective study of all patients admitted to a Level 1 trauma center with isolated gunshot injury to the head during 6 1/2 years. ⋯ Indicators of outcome are the admission Glasgow Coma Scale score, pupillary abnormality, metabolic acidosis, and CT pattern of severe injury. The majority of deaths occur at an early stage. Among survivors the functional outcome can be acceptable.
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The American surgeon · Mar 2009
Alcohol's role on the reliability of clinical examination to rule out pelvic fractures.
The objective of this study was to determine if clinical examination accurately ruled out pelvic fractures in intoxicated patients sustaining blunt trauma A prospective comparison of intoxicated (blood alcohol level [BAL] greater than 0.08 g/dL) to nonintoxicated (BAL less than 0.08 g/dL) patients sustaining blunt trauma was performed between February 2004 and March 2007. Clinical factors were compared and subset analysis performed in which patients with factors known to compromise the clinical examination were excluded. Two hundred ninety-six intoxicated patients were compared with 1071 nonintoxicated patients. ⋯ There were eight pelvic fractures diagnosed in this group and no missed injuries on clinical examination (sensitivity 100%). Clinical examination was not compromised by intoxication. Routine pelvic x-rays are not needed in the alert, intoxicated patient sustaining blunt trauma.