The American surgeon
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About 20 per cent of patients with carcinoma of the colon or rectum present with metastatic disease. Surgeons are frequently asked to consider resection or other operative procedures in these patients for palliation. We performed this review to determine whether patients presenting with known metastatic colorectal cancer derive benefit from surgical intervention. ⋯ Although metastatic colorectal carcinoma cannot usually be cured by surgical intervention, many patients who present with metastatic disease will benefit from palliative operations with relatively short hospitalizations and reasonable survival. Those who are not candidates for resection of the primary tumor have shorter survival times. Surgery can alleviate many of the distressing symptoms in patients with metastatic colorectal carcinoma.
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The American surgeon · Apr 2004
Comparative StudyIncisional hernia after repair of wound dehiscence: incidence and risk factors.
The true incidence of incisional hernia after wound dehiscence repair remains unclear because thorough long-term follow-up studies are not available. Medical records of all patients who had undergone wound dehiscence repair between January 1985 and January 1999 at the Erasmus University Medical Center Rotterdam were reviewed. Long-term follow-up was performed by physical examination of all patients in February 2001. ⋯ Suture material did not influence incidence of incisional hernia. Incisional hernia develops in the majority of patients after wound dehiscence repair, regardless of suture material or technique. Aneurysm of the abdominal aorta and severe dehiscence with evisceration predispose to incisional hernia.
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The American surgeon · Apr 2004
Comparative StudyThe ultrasound screen for penetrating truncal trauma.
A prospective blinded pilot study was performed at an urban level 1 trauma center to evaluate the efficacy of ultrasound in ruling out penetrating visceral truncal injury. For 8 months, 49 nonconsecutive patients who presented with truncal gunshot and stab wounds were evaluated by a 10-MHz ultrasound tranducer probe. The deepest muscle bundle and the fascia enveloping it was examined by ultrasound. ⋯ The specificity and positive predictive value are both approximately 50 per cent. Ultrasonic examination of the injured abdominal wall layers in truncal penetrating trauma is an excellent screening tool. Simple comparative assessment with the unaffected contralateral side allows a highly sensitive method of decreasing the number of potentially morbid, time consuming, and expensive tests that are currently employed to rule out visceral injury.
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The American surgeon · Apr 2004
Comparative StudyAge, blood transfusion, and survival after trauma.
Blood transfusion affects outcomes after trauma, but whether elderly patients are disproportionately affected remains unknown. To determine the possible interaction between age, packed cell transfusion volume (PCTV), and mortality after injury, we designed a 6-year retrospective review (January 1995 through December 2000) of patients > or = 16 years of age who received blood transfusion within the first 24 hours after injury. One thousand three hundred twelve patients > or = 16 years of age admitted to our trauma center received packed red blood cells in the initial 24 hours after admission. ⋯ Furthermore, mean PCTV for all survivors decreased progressively with advancing age. No patient >75 years with a PCTV > 12 units survived. Age and PCTV act independently, yet synergistically to increase mortality following injury.
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The American surgeon · Apr 2004
Evaluation of initial base deficit as a prognosticator of outcome in the pediatric trauma population.
Although the utility of the base deficit as an indicator of hypoperfusion and physiologic derangement in adults is well established, its value in the assessment of children is not as clear. The purpose of this study was to evaluate this tool with regard to injury severity, infectious morbidity, and outcome in a pediatric trauma population. A retrospective review of a 6-year period of the database of our level 1 pediatric trauma center was performed. ⋯ Likewise, the number of infectious complications rose 26 per cent with a worsening initial base deficit from 17 per cent of group 2 patients to 43 per cent of group 1 patients. We conclude that a high initial base deficit in injured children predicts a higher incidence of infectious complications and a less favorable outcome. This readily available laboratory study can identify those children most at risk of potentially preventable complications.