The American surgeon
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The American surgeon · Dec 2004
A review of upper extremity fasciotomies in a level I trauma center.
The purpose of this study was to review recent experience with upper extremity fasciotomy. This study is a retrospective review of injured patients undergoing fasciotomy in the upper extremity at an urban trauma center. Mechanisms of injury, indications for and timing of fasciotomy, role of compartment pressures, techniques of closure, amputation rate, and patient outcomes were collected. ⋯ In the remaining 20 patients, closure of the fasciotomy site was performed at a mean of 9 days (range, 2 to 22) after injury, most commonly by split thickness skin grafting. Hospital stay was a mean of 20 days (range, 7-35). We conclude that 1) upper extremity fasciotomy accounts for less than 20 per cent of all fasciotomies performed; 2) a clinical decision is the most common reason for performing upper extremity fasciotomy, and only 11 per cent of patients underwent a delayed fasciotomy in this review; 3) the need for upper extremity fasciotomy is associated with a length of stay longer than expected for overall injury severity.
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Traumatic rupture of the thoracic aorta is potentially life-threatening and leads to death in 75 to 90 per cent of cases at the time of injury. In high-risk patients, as traumatic injuries of the aorta combine with multiple associated injuries, endoluminal repair is now reported as a promising therapeutic strategy with encouraging results. This study determined the outcome of patients with traumatic thoracic aortic injury treated endovascularly during the past 7 years at our institution. ⋯ Two additional stent-graft procedures were performed due to type I endoleaks after 18 and 28 months. There was no other intervention-related morbidity or mortality during the mean follow-up time of 26.4 months' (range, 6-86). Endovascular stent-graft repair of traumatic thoracic aortic injuries is a safe, effective, and low-morbidity alternative to open thoracic surgery and has promising midterm results.
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The American surgeon · Dec 2004
Admission serum albumin is predicitve of outcome in critically ill trauma patients.
There is a paucity of data evaluating serum albumin on admission as a predictor of outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia on admission is a predictor of adverse outcome in trauma patients. Prospective data was collected daily on 1023 patients over a 2-year period. ⋯ An admission serum albumin level of <2.6 g/dL is a significant independent predictor of morbidity and mortality in trauma patients. The combination of increased age and low albumin level was most predictive of infection and mortality. Early nutrition should be considered in these high-risk patients.
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The American surgeon · Nov 2004
Randomized Controlled Trial Clinical TrialLocal anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.
Pain after an open inguinal hernia repair may be significant. In fact, some surgeons feel that the pain after open repair justifies a laparoscopic approach. The purpose of this study was to determine if the use of local anesthetic infusion pumps would reduce postoperative pain after open inguinal hernia repair. ⋯ This significant difference continued even after the infusion pumps were removed. Local anesthetic infusion pumps significantly decreased the amount of early postoperative pain. Pain relief persisted for 2 days after catheter and pump removal.
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The American surgeon · Nov 2004
Case ReportsUnrecognized foreign body ingestion: an unusual cause for abdominal pain in a healthy adult.
An unusual case of a unrecognized foreign body ingestion in a healthy, reliable adult patient is reported. A diagnosis of a foreign body perforation of the stomach was made on computed tomographic imaging of the abdomen that was obtained for evaluation of unremitting pain. This case emphasizes the importance of considering foreign body ingestion in the differential diagnosis for abdominal pain of unknown etiology.