The American surgeon
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The American surgeon · Sep 2007
Antibiotic therapy and interval appendectomy for perforated appendicitis in children: a selective approach.
The role of initial nonoperative treatment in pediatric perforated appendicitis remains controversial. We examined our outcomes after using this approach in a selective manner. Children with perforated appendicitis treated during a 28-month period were retrospectively reviewed. ⋯ Average total hospital stay was 7.2 +/- 3.0 days. Initial nonoperative treatment is highly successful in selected children who meet specific criteria. Failure is not associated with increased morbidity.
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The American surgeon · Sep 2007
Medical admission of elderly trauma patients with isolated injuries.
We sought to evaluate the outcomes of trauma patients admitted to medical services rather than to the general trauma team, particularly those elderly patients with isolated injuries of a specialty nature. Over the 2-year retrospective study period, 3017 trauma patients were admitted. The trauma service directed care in 2740 (90.8%) of this group versus the 277 (9.2%) admitted to medical services (MS). ⋯ There was a higher morbidity rate, 41.9 per cent, in the trauma service group as compared with the MS group, 20 per cent. No patients on the MS underwent a laparotomy for intraabdominal injuries nor were there any missed injuries of a general surgical nature. Allowing elderly trauma patients with isolated specialty injuries to be managed by the MS is not associated with increased morbidity or mortality.
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Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter, and rarely cause symptoms. However, "giant" peritoneal loose bodies, larger than 5 cm in diameter, presenting with various symptoms have been also reported. ⋯ The patient refused any treatment at his first visit but accepted surgical removal of the peritoneal loose body 5 years later. The size of the peritoneal loose body has increased from 7.3 cm to 9.5 cm in diameter during this observation period.
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The American surgeon · Sep 2007
Case ReportsConservative management of nongangrenous esophageal and gastric pneumatosis.
Pneumatosis intestinalis, or air within the wall of the gastrointestinal tract, has been documented from the esophagus to the rectum. Its presence can suggest gangrenous changes of the stomach or colon and represents a surgical emergency. However, pneumatosis intestinalis can also occur as a result of a benign, nongangrenous condition. We report the conservative management of a patient with nongangrenous gastric and esophageal pneumatosis.
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The American surgeon · Sep 2007
Comment Letter Case ReportsWhipple procedure for chronic pancreatitis in a Jehovah's Witness.