The American surgeon
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The American surgeon · Aug 2002
Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study.
Blunt trauma to the pancreas is an uncommon injury, which can be difficult to diagnose. Most studies are multi-institutional, include both helical and axial CT, and report sensitivities of 40 to 67 per cent. We evaluated the efficacy of spiral CT for the diagnosis of blunt pancreatic injury in a single large-volume institution. ⋯ We conclude that CT scan is only moderately sensitive and can underestimate or miss pancreatic injury. Although CT moderately correlated with injury grade it was highly predictive for presence of injury. The new multidetector helical scanner may improve our diagnostic ability.
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The American surgeon · Aug 2002
Obturator bypass: a classic approach for the treatment of contemporary groin infection.
As the number of cardiac and interventional radiologic procedures has risen, the frequency with which surgeons are called to treat groin complications has increased. Infectious groin problems that often involve foreign prosthetic material or remnants of percutaneous femoral closure devices are particularly challenging and require control of bleeding, removal of foreign material, wide debridement, and sometimes arterial resection. Management of the consequential limb ischemia in such cases is controversial. ⋯ There were no late graft infections. We conclude that the obturator bypass is an effective and durable means of revascularization in the presence of the septic groin. This procedure belongs in the armamentarium of all surgeons managing these complications.
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The American surgeon · Jul 2002
Blood transfusions correlate with infections in trauma patients in a dose-dependent manner.
Infections are a common and significant sequela of major traumatic injury. The objective of this study was to evaluate the relationship between infections in trauma patients and the transfusion of packed red blood cells (pRBCs) within the first 48 hours of admission. We hypothesized that transfusions of pRBCs were associated with an increased risk of infection in a dose-dependent manner. ⋯ In summary there is a clear dose-dependent correlation between transfusions of pRBCs and the development of infection in trauma patients. Multivariate analysis further demonstrated that pRBCs were an independent risk factor for the development of infections. Although transfusions are frequently indicated, they should be administered appropriately and with no more pRBCs than absolutely necessary.
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Prompt diagnosis of acute traumatic injury to the diaphragm remains a challenge when the admission chest X-ray is unrevealing and immediate laparotomy or thoracotomy is not indicated. Diagnostic delay may contribute to significant morbidity and mortality. A retrospective review of our 15-year experience with diaphragm injury (DI) revealed 13 patients (nine male/four female; mean age, 40 +/- 34 years) who sustained injuries to the left (77%) and right (23%) diaphragm respectively as a result of motor vehicle crashes (MVCs) (69%), penetrating trauma (30%), and pedestrian-versus-car accidents (1%). ⋯ She is scheduled for exploration in the near future. DI particulary after blunt trauma and on the right side may be missed in the absence of other indications for immediate surgery because radiographic abnormalities of the diaphragm particularly on the right are often attributed to thoracic pathology or may be absent initially. A high index of suspicion for DI may help lead to an earlier diagnosis especially when the patient's clinical condition fails to improve.
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The American surgeon · Jul 2002
Major lower-extremity amputation: contemporary experience in a single Veterans Affairs institution.
Our objective is to describe our current experience with major lower-extremity amputation secondary to vascular disease. We conducted a retrospective review of sequential amputations over a 3-year period at one Veterans Affairs institution. One hundred thirteen amputations were performed in 99 men (age 70 +/- 11 years). ⋯ One-year mortality is high. Low rehabilitation rates especially in dialysis patients mandate further efforts in this regard. Vigilant follow-up of the contralateral limb is essential.