The American surgeon
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Blunt thoracic aortic injury (BAI) is a rare but often fatal injury that occurs with severe polytrauma. Immediate diagnosis and treatment of BAI are essential for a successful outcome. We reviewed our experience with 20 patients with BAI treated at a Level I trauma center between 1995 and 2006. ⋯ BAI is rare and often associated with multiple life-threatening injuries complicating diagnosis and treatment. Our data support the aggressive use of CTA even when classic CXR findings are not present. When CT must be delayed for abdominal exploration, intraoperative TEE is useful.
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The American surgeon · Oct 2008
Comparative StudyBlood transfusions in trauma: six-year analysis of the transfusion practices at a Level I trauma center.
The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. ⋯ The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.
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The American surgeon · Oct 2008
Comparative StudyThe Surgical Care Improvement project (SCIP) initiative to reduce infection in elective colorectal surgery: which performance measures affect outcome?
One component of the Surgical Care Improvement Project (SCIP) is the prevention of surgical site infections (SSIs) by: 1) timing the administration of prophylactic antibiotics (PAs) within 1 hour of incision; 2) using approved PA regimens; and 3) discontinuing PA within 24 hours. We sought to evaluate institutional compliance with SCIP recommendations in patients undergoing elective colorectal surgery and determine whether they affected the incidence of SSI. One hundred four elective colorectal cases were reviewed. ⋯ There was no significant difference in the incidence of SSI in patients who received compliant versus noncompliant PA (12.7% vs 9.1%, P = 0.75). Timely PA administration significantly reduces the incidence of SSI in patients undergoing elective colorectal surgery. Efforts should focus on ensuring that PAs are given in a timely manner to reduce SSI in colorectal surgery.
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The American surgeon · Oct 2008
Multicenter Study Comparative StudyManagement of high-grade splenic injury in children.
Using the National Trauma Databank, we identified 413 children (age < or = 14 years) who sustained high-grade blunt splenic injury (Abbreviated Injury Scale scores > or = 4) from 2001 to 2005. Overall mortality was 13.5 per cent. Early operation within 6 hours of injury (EOM) was performed in 128 patients (31%). ⋯ Failure of NOM was associated with increased mortality compared with successful NOM, but had similar mortality and length of hospital or intensive care unit stay compared with EOM. We conclude that operative treatment is necessary in nearly half of pediatric patients with high-grade splenic injury. With careful selection, nonoperative management is usually successful but must include close monitoring, because 16 per cent required delayed operation.
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The American surgeon · Oct 2008
Comparative StudyRemission of diabetes after laparoscopic gastric bypass.
Diabetes is a well-recognized and treatable risk factor for cardiac disease, and one of many comorbidities associated with obesity. The aim of this study was to evaluate the clinical outcome of a cohort of morbidly obese patients with documented diabetes who underwent laparoscopic Roux-en-Y gastric bypass. Fifty-nine patients with sufficient follow-up were included in the study. ⋯ Patients with remission of diabetes had a shorter length of condition compared with patients with only improvement (43 vs 103 months, P < 0.01). Weight loss associated with laparoscopic gastric bypass significantly improves diabetes control and results in discontinuation or marked reduction of antidiabetic medications in the majority of patients. Improvement in glucose control occurs as early as 1 month postoperatively.