The American surgeon
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The American surgeon · Jun 2005
Review Case ReportsSynchronous diverticular perforation: report of a case.
Synchronous colonic events are rare. Diverticulitis is the most common and lethal cause of colonic perforation. The first case in the literature of a synchronous diverticular perforation is presented. ⋯ Right-sided free colonic perforation is rare. Resection and primary anastomosis is feasible in the treatment of perforated diverticular disease. In this report, we emphasize the importance of a thorough abdominal exploration at the time of surgery.
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The American surgeon · Jun 2005
Comparative StudyPrevalence of delayed hemothorax in blunt thoracic trauma.
Delayed hemothorax (DHTX) is rarely seen. On an 8-year retrospective analysis of blunt thoracic trauma (BTT), hemothorax (HTX) was diagnosed in 167 patients: 18 children, 113 adults, and 36 elderly. No statistical differences were seen in any age groups regarding Injury Severity Score (mean ISS, 30.54), critical care length of stay (CLOS, 9.0), and hospital LOS (HLOS, 11.21). ⋯ Eighty-six per cent of DHTX and 49 per cent of AHTX patients went home on discharge. DHTX was rare (5%) in the current report with lower ISS, HLOS, and no mortality. Patients with rib fractures should be watched for development of DHTX as timely diagnosis and treatment is essential for favorable outcome.
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Thyroid injury is a rare phenomenon in cases of blunt neck trauma. Symptoms are often subtle or not present on initial exam and can be rapidly life-threatening when airway compromise ensues. We describe the case of a 50-year-old woman who developed neck pain and swelling, dysphagia, and hoarseness after a rear-end collision in which she was the restrained driver, hitting her anterior neck against the steering wheel. ⋯ The patient was observed in the ICU and was discharged home 3 days later without operative intervention. We believe that in the acute setting, a stable traumatic thyroid hematoma without airway encroachment may be safely observed. Increasing size or compromise of airway integrity should be indications for early intubation and neck exploration.
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The American surgeon · Jun 2005
Comparative StudyNeoadjuvant chemotherapy in stage III breast cancer.
Neoadjuvant chemotherapy in advanced breast cancer can potentially downstage disease prior to definitive surgery. In this study, a doxorubicin-based neoadjuvant regimen was administered to stage III breast cancer patients to assess 1) primary tumor response, 2) tumor involvement of resection margins, and 3) predictive value in cancer outcome. Eighty-two patients with stage IIIA and IIIB breast cancer diagnosed between 1990 and 2003 were studied. ⋯ Survival analysis demonstrated no benefit comparing neoadjuvant versus postoperative adjuvant therapy but hints at improved disease-free survival in neoadjuvant CR patients (log-rank test, P = 0.07). Eighty-five per cent of patients with stage III breast cancer treated with neoadjuvant chemotherapy experienced clinical response, with 26 per cent CR, and 97 per cent tumor-free resection margins. CR may portend a better cancer outcome.
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The American surgeon · May 2005
Comparative StudyInitial chest tube management after pulmonary resection.
Tube thoracostomy management with suction or water seal after anatomical pulmonary resection remains somewhat controversial. Initial chest tube management may influence the duration of pleural fluid drainage, duration of tube thoracostomy, and/or hospital length of stay following pulmonary resection. We hypothesized that initial chest tube management with water seal decreases time for chest tube removal and decreases time of hospital stay. ⋯ In the air leak group (n = 31), 7 (23%) patients were managed with water seal and 24 (77%) patients with suction. Both duration of chest tube (P = 0.001) and length of hospital stay (P < 0.05) were significantly lower in the water seal group. In patients without air leak, chest tubes should be managed with water seal following anatomical pulmonary resection, resulting in significantly shorter chest tube duration and hospital length of stay.