The American surgeon
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The role of laparoscopy (LS) in abdominal trauma is controversial. Concerns remain regarding missed injuries and safety. Our objective for this study was to determine the safety and better define the role of LS in abdominal trauma victims. ⋯ LS was most valuable in penetrating trauma, avoiding laparotomy in more than two-thirds of patients with suspected intra-abdominal injury. LS can serve as a useful adjunct for the evaluation of blunt trauma. In a level I trauma center with LS readily available, the procedure is associated with a low rate of complications and missed injury.
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The American surgeon · Nov 2003
Case ReportsFalse-negative plain cervical spine x-rays in blunt trauma.
Although considered very accurate, false-negative plain cervical radiographs of blunt trauma patients will occur with potentially devastating complications. We sought to define the population of patients who fall into this category and the overall accuracy of adequate three-view cervical spine radiography in the blunt trauma population. A retrospective search was carried out of blunt trauma patients entered into our trauma registry. ⋯ Sensitivity was 90.3 per cent, specificity was 96.3 per cent, positive predictive value was 54.9 per cent, and negative predictive value was 99.5 per cent. Three-view plain radiograph series of the cervical spine remains a highly sensitive and specific test for cervical spine injury following blunt trauma. However, the fact that we identified three patients with significant fractures after negative plain radiographs suggests that serious consideration of computed tomography must be applied in treating symptomatic, high-risk blunt trauma patients when plain radiographs do not reveal an injury.
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The American surgeon · Oct 2003
Analysis of causes and prevention of early readmission to surgical intensive care.
The purpose of this study was to analyze causes of early readmission to the surgical intensive care unit (SICU), to determine whether readmission can be predicted or prevented, and to compare outcomes of patients readmitted to the SICU with patients not requiring readmission. All patients admitted to the Cedars-Sinai SICU from January 1, 1996, to December 31, 2001, were included. Clinical data was prospectively collected in an on-line computer system. ⋯ Upon review, 62 per cent of all readmissions met appropriate SICU discharge criteria and were not predictable while only 5 per cent of SICU discharge were felt to have been premature. Patient outcomes are adversely affected by early readmission to the SICU. Careful neurologic assessment, meticulous attention to respiratory care transfer orders, and prompt respiratory therapy on floor care may significantly decrease the need for early readmission to the SICU.
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Profound pulse oximetery desaturations are observed following isosulfan blue dye injection during breast sentinel node biopsy. The objective of this study was to examine the effect isosulfan dye has on oxygenation status and the reliability of pulse oximetery in evaluating this parameter. After study design, institutional review board approval was obtained. ⋯ The mean oximetry SpO2 desaturation was 5.6 per cent, with a range to 9 per cent. After injection with isosulfan blue dye, a significant SpO2 desaturation occurs. Clinicians must be aware of the factitious effect isosulfan blue dye has on SpO2 monitoring, to assess accurately the oxygenation status of the anesthetized patient.
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Conflicting evidence exists regarding the optimal treatment for abscess complicating acute appendicitis. The objective of this study is to compare immediate appendectomy (IMM APP) versus expectant management (EXP MAN) including percutaneous drainage with or without interval appendectomy to treat periappendiceal abscess. One hundred four patients with acute appendicitis complicated by periappendiceal abscess were identified. ⋯ IMM APP patients had a higher rate of complications than EXP MAN patients at initial hospitalization (58% vs. 15%, P < 0.001) and for all hospitalizations (67% vs. 24%, P < 0.001). The IMM APP group also had a longer initial (14.8 +/- 16.1 vs. 9.0 +/- 4.8 days, P = 0.01) and overall hospital stay (15.3 +/- 16.2 vs. 10.7 +/- 5.4 days, P = 0.04). We conclude that percutaneous drainage and interval appendectomy is preferable to immediate appendectomy for treatment of appendiceal abscess because it leads to a lower complication rate and a shorter hospital stay.