The American surgeon
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The American surgeon · Aug 2008
Blood glucose variability is associated with mortality in the surgical intensive care unit.
Intensive insulin therapy has widely and rapidly been adopted as the standard of care for the treatment of hyperglycemia in the intensive care unit (ICU). Variability in blood glucose is increasingly recognized as an important factor in outcomes in the chronic diabetic in addition to hemoglobin A1C. We tested the hypothesis that measures of blood glucose variability would be associated with mortality in the surgical ICU. ⋯ Several measures of blood glucose variability (maximum successive change in BG and the triangular index) were different between the groups despite similar mean BG between survivors (117 mg/dL) and nonsurvivors (118 mg/dL). Increased blood glucose variability is associated with mortality in the surgical ICU. Further studies should focus on the demographic, clinical, and genetic factors responsible for this observation and identify strategies to minimize BG variability.
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The American surgeon · Aug 2008
Combined open and laparoscopic approach to chronic pain after inguinal hernia repair.
Chronic groin pain is the most frequent long-term complication after inguinal hernia repair affecting up to 34 per cent of patients. Traditional surgical management includes groin exploration, mesh removal, and neurectomy. We evaluate outcomes of a combined laparoscopic and open approach to chronic pain after inguinal herniorrhaphy. ⋯ With a minimum of 6 weeks follow-up, 20 of 21 patients reported significant improvement or resolution of symptoms. A combined laparoscopic and open approach for postherniorrhaphy groin pain results in excellent patient satisfaction with minimal morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after hernia repair.
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The American surgeon · Jul 2008
Comparative StudyThe role of CT angiography in the diagnosis of blunt traumatic thoracic aortic disruption and unsuspected carotid artery injury.
We have replaced aortography and open thoracic surgery to diagnose and treat blunt traumatic thoracic aortic disruption (TTAD) in favor of CT angiography (CTA) and endovascular repair. The purpose of this study is to review our experience with the management and outcomes of TTAD and associated carotid artery injuries. In January 2003, we initiated a protocol that used CTA to evaluate all patients with suspected TTAD from blunt trauma. ⋯ One patient with a common carotid-innominate artery dissection and pseudoaneurysm underwent endovascular repair. This study indicates that CTA and endovascular repair provide accurate diagnostic and therapeutic results in the management of blunt TTAD. Furthermore, CTA should include arch and cervical views to detect an unsuspected, concomitant carotid artery injury.
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The American surgeon · Jul 2008
Comparative StudyEmergent and elective colon surgery in the extreme elderly: do the results warrant the operation?
With the elderly population rising continuously, surgeons are increasingly confronted by the dilemma of operative management in these patients, which frequently encompasses end-of-life issues. Increasing age and emergent surgery are known risk factors for poor outcomes in colon surgery. The purpose of this study is to delineate differences in outcomes between emergent and elective colon surgery and identify risk factors that can guide the surgeon in caring for the extreme elderly (age 80 years or older). ⋯ Percentage of patients discharged to home was significantly less in the emergent group (13% vs 59%, P < 0.001). Evaluation of the emergent surgery group revealed male gender, history of smoking, and ischemic changes on pathologic examination were statistically significant risk factors for failure of surgery. As a result of the high-risk nature of emergent colon operations in the extreme elderly, it is important that surgeons carefully assess the benefits in relation to the risks and functional outcomes of surgery when planning patient care and providing informed consent.
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The American surgeon · Jun 2008
Comparative StudyAcetabular and isolated pelvic ring fractures: a comparison of initial assessment and outcome.
The purpose of this study was to describe the comparative outcomes of patients with pelvic ring fractures, acetabular fractures, and combinations of the same. Patients with pelvic or acetabular fractures were identified in the Hospital Trauma Registry, and all appropriate data were collected by reviewing the patients' medical records, the hospital operative logs, transfusion records, and the records of surgical morbidity conferences. Patient management was consistent over the time period of the study. ⋯ Patients with pelvic ring fractures have a worse admission base deficit, higher transfusion requirements, and increased hypotension on admission. This is reflected in their significantly higher mortality and longer hospital and intensive care unit LOS in survivors. Such clinical information is helpful when caring for patients with acetabular vs pelvic ring fractures.