The American surgeon
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In intubated patients the presence of a cuff leak (CL) is used as a predictor of successful extubation. CL is proposed to indicate laryngeal edema and predict which patients may develop complications such as postextubation stridor and eventual reintubation. Our objective was to evaluate the reliability of CL in our population of critically ill trauma patients. ⋯ Four patients (10%) in the +CL cohort failed extubation, whereas none of the -CL cohort failed (0%) (P = 0.40). The CL test does not reliably identify those patients who will require reintubation in our trauma population. In addition, the ratio of ETT and tracheal diameter is not predictive of successful extubation.
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The American surgeon · Dec 2008
Does fever at the time of discharge have any impact on the incidence of readmission?
Most physicians believe that patients who have fever within 24 hours of the planned date of discharge should be kept in the hospital until the fever resolves. A search of the literature revealed very few articles addressing this topic. The object of this study was to review a number of patient discharges from the surgical service and to document the presence or absence of fever within 24 hours of the time of discharge. ⋯ The rate of readmission for fever and nonfever patients was not statistically significantly different (P = 0.697). Similarly, the rate of related versus nonrelated diagnoses in both the fever and nonfever groups was not statistically significantly different (P = 0.351). The presence or absence of fever within 24 hours of patient discharge seems to have no impact on the rate of readmission within 30 days.
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The American surgeon · Dec 2008
Case ReportsEarly thrombosis of the superior vena cava in a patient with a central venous catheter and carcinoma of the ampulla of Vater.
Superior vena cava syndrome results from obstruction of flow through the vessel either by external compression or thrombosis. External compression by intrathoracic neoplasms is the most common etiology. Thrombosis of the vessel most often occurs in the setting of indwelling catheters or pacemakers. ⋯ In this report, we present a patient who developed superior vena cava thrombosis after undergoing a short period of central venous catheterization and a Whipple procedure for adenocarcinoma of the ampulla of Vater. The endothelial damage caused by the catheter, the low-flow state induced by the large fluid shifts during the operation, and the hypercoagulable state induced by malignancy fulfill Virchow's triad for venous thrombosis. To our knowledge, this is the first reported case of superior vena cava syndrome after the Whipple procedure with symptoms appearing after a shorter period of catheterization than previously reported in the adult literature.
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The American surgeon · Nov 2008
Adding insult to injury: neck exploration for penetrating pediatric neck trauma.
Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration. ⋯ The hospital length of stay was longer in the patients who underwent exploration. Mandatory exploration of the neck in children should not be performed unless clinically indicated. Preoperative imaging should be used liberally to limit nontherapeutic explorations, improve diagnostic accuracy, and reduce morbidity.