The American surgeon
-
The American surgeon · Aug 2003
Inferior vena cava filter placement: preinsertion inferior vena cava imaging.
Imaging of the vena vava prior to the insertion of an inferior vena vava (IVC) filter is mandatory to assess IVC diameter and patency, delineate anatomy and venous anomalies, and to direct filter placement for appropriate deployment and avoidance of complications. The standard imaging technique is vena cavography, although alternative methods to evaluate the inferior vena cava include carbon dioxide venography, transabdominal duplex ultrasound, and intravascular ultrasound. This manuscript will review the anatomical features, technique, and complications of pre-insertion inferior vena cava imaging and discuss alternative methods to evaluate the inferior vena cave prior to filter insertion.
-
The objective of this study was to identify changes in the management of blunt splenic injury in adults. Hospital discharge abstract data from Maine were used to identify patients > or = 16 years old discharged between January 1, 1981 and December 31, 2000 with International Classification of Diseases (9th revision) codes indicating splenic injury. Incidence of operative intervention and outcomes for trauma hospitals and other hospitals were determined. ⋯ There has been a marked decrease in rate of operative intervention for splenic injury in adults especially in the last 10 years. Rates of operative intervention were lower at the trauma hospitals despite higher injury severity. Frequency of delayed intervention was low and did not increase with lower operative rate.
-
The American surgeon · Jun 2003
Comparative StudyThe impact of pelvic and lower extremity fractures on the incidence of lower extremity deep vein thrombosis in high-risk trauma patients. Winner of the Best Paper Award from the Gold Medal Forum.
Lower extremity fractures (LEFx) and pelvic fractures (PFx) are believed to increase the risk of lower extremity deep vein thrombosis (LEDVT). We studied trauma patients at high risk for LEDVT to determine whether an increased incidence of LEDVT was associated with LEFx and/or PFx. From January 1995 through December 1997 4163 trauma patients were admitted to our Level I trauma center. ⋯ The power of this study to detect differences representing medium effect sizes was greater than 90 per cent. We conclude that LEFx and/or PFx was not associated with an increased incidence of LEDVT in trauma patients at high risk for LEDVT. Lower extremity venous duplex ultrasound needs to be performed in both Fx and NFx groups to detect LEDVTs.
-
The American surgeon · Jun 2003
Comparative StudyThe relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury.
The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. ⋯ Bivariate analysis revealed no ISS correlation with FIM-G (r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.
-
The American surgeon · Jun 2003
Case ReportsHepatic portal vein gas: clinical features and outcomes.
Hepatic portal vein gas (HPVG) is found as branching gas extending to near the periphery of the liver. Increased utilization of CT may identify HPVG in more patients. In the past HPVG was associated with acute abdomen and high mortality. ⋯ Physical examination and laboratory findings were not reliable indicators of intra-abdominal catastrophe. Furthermore CT scans are inaccurate for predicting the etiology of HPVG. Close observation may be appropriate in stable patients with HPVG without other specific findings.