The American surgeon
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The American surgeon · Oct 2007
Computed tomographic brain density measurement as a predictor of elevated intracranial pressure in blunt head trauma.
There are no independent computed tomography (CT) findings predictive of elevated intracranial pressure (ICP). The purpose of this study was to evaluate brain density measurement on CT as a predictor of elevated ICP or decreased cerebral perfusion pressure (CPP). A prospectively collected database of patients with acute traumatic brain injury was used to identify patients who had a brain CT followed within 2 hours by ICP measurement. ⋯ There was no difference in brain density measurement for observer 1, ICP less than 20 (26.3 HU) versus ICP 20 or greater (27.4 HU, P = 0.545) or for CPP less than 70 (27.1 HU) versus CPP 70 or greater (26.2, P = 0.624). Similarly, there was no difference for observer 2, ICP less than 20 (26.8 HU) versus ICP 20 or greater (27.4, P = 0.753) and CPP less than 70 (27.6 HU) versus CPP 70 or greater (26.2, P = 0.436). CT-measured brain density does not correlate with elevated ICP or depressed CPP and cannot predict patients with traumatic brain injury who would benefit from invasive ICP monitoring.
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A retrospective review was conducted to analyze the effect of methamphetamine use in trauma patients. Charts of all trauma patients admitted to Kern Medical Center from January 1, 2003, to January 5, 2006 (36 months) were analyzed for length of stay, intensive care unit (ICU) admission rate and number of ICU days, ventilator days, and mortality. Results were compared in patients testing positive for methamphetamine (M+) with those who tested negative (M-). ⋯ A trend toward decreased mortality was noted in M+ patients (P = 0.0778). ISS subset analysis demonstrated an increased ICU admission rate in M+ patients in ISS group 1-5 (P = 0.0002). There was also an increased length of stay in M+ patients within the ISS 6-10 group (8 versus 5 days, respectively, P = 0.015).
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The American surgeon · Sep 2007
Review Case ReportsEikenella corrodens causing necrotizing fasciitis after an elective inguinal hernia repair in an adult: a case report and literature review.
We report an unusual case of necrotizing fasciitis in a 43-year-old man after elective inguinal hernia repair. The patient presented to the emergency department 9 days postoperatively with high fevers, tachycardia, and crepitus along his abdominal wall. ⋯ Patients can develop necrotizing fasciitis after elective, clean procedures and should be adequately resuscitated, undergo immediate surgical debridement, and receive antibiotics. Laparoscopy can be useful in determining if intraabdominal pathology is the cause of the infection and a wound vacuum-assisted device is a cost-effective way to decrease healing times.
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The American surgeon · Sep 2007
Controlled Clinical TrialIntraabdominal hypertension in patients with septic shock.
Intraabdominal hypertension (IAH) develops frequently in patients with septic shock. Even a moderate increase in intraabdominal pressure (IAP) in this setting could be associated with high lactate levels. The authors conducted a prospective, observational, nonrandomized control trial in the surgical intensive care unit of an academic tertiary center. ⋯ Control patients with and without IAH exhibited comparable peak lactate levels. Intraabdominal hypertension is very common in septic shock and appears to be related to high lactate levels, which diminish as IAP decreases. Future studies should address the usefulness of IAP monitoring in patients with septic shock.
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The American surgeon · Sep 2007
Early selective angioembolization improves success of nonoperative management of blunt splenic injury.
The role of angioembolization in the management of patients with blunt spleen injury is still under debate. Our study examined the impact of splenic artery embolization (SAE) on the outcome of such patients. We reviewed 114 consecutive blunt abdominal trauma patients with isolated splenic injury over a period of 40 months, including 61 patients seen before (Group A) and 53 patients seen after (Group B) the adoption of SAE. ⋯ SAE was successful to control bleeding in 80 per cent of patients. Partial splenic infarction was noted in all patients after the procedure but it resolved by six months. By using criteria developed based on abdominal CT scans for angioembolization, we are able to improve nonoperative splenic salvage rate.