The American surgeon
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Scrotal and perineal gangrene of the male genitalia was first described by Fournier in 1883. Treatment of the disease remains surgical despite the availability of modern antibiotics. Many authors advocate a wide debridement of all tissue superficial to the involved fascial layers. ⋯ The mean hospital stay of this group was 62+/-12 days. The specific flora included: Bacteroidis fragilis in 87 per cent, Peptostreptococcus and Streptococcus in 75 per cent, Clostridia group, Escherichia coli, Enterobacter and Pseudomonas in 62 per cent, Klebsiella in 50 per cent, Staphylococcus in 37 per cent, and Proteus in 12 per cent of the patients. In the surgical management of Fournier's gangrene, wide drainage with minimal debridement resulted in similar morbidity and shorter hospital stay when compared with extensive debridement.
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The American surgeon · Oct 1999
Comparative StudyNosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients.
In 1970, the Centers for Disease Control and Prevention (CDC) established the National Nosocomial Infection Surveillance System to assist institutions with infection surveillance, data collection, and processing. This facilitates interinstitutional comparison for nosocomial infection rates. Nosocomial infection rates in the surgical intensive care unit have been shown to be different from the medical intensive care unit. ⋯ We conclude that trauma patients are at higher risk for nosocomial infections than routine surgical patients. Because of this difference, centers should collect and report data separately for trauma and surgical patients in the intensive care unit. Specific attention should be focused on the causes and prevention of increased rates of nosocomial pneumonia in trauma patients.
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Recent studies have reported an increased risk of intra-abdominal abscess formation following laparoscopic operation for perforated appendicitis. We undertook this study to compare laparoscopic versus open appendectomy in the treatment of perforated appendicitis. Records of all patients undergoing an appendectomy between January 1994 and June 1997 were reviewed, classifying appendicitis as acute, gangrenous, or perforated based on the intraoperative findings. ⋯ Ten patients (1.4%) developed an intra-abdominal abscess: six after open appendectomy (1.7%), one after converted appendectomy (3.7%), and three after laparoscopic appendectomy (1%). There was no significant difference in rate of abscess formation in patients with perforated appendicitis undergoing open, converted, or laparoscopic appendectomy. We conclude that laparoscopic appendectomy for perforated appendicitis is not associated with an increased rate of intra-abdominal abscess formation.
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The American surgeon · Oct 1999
Abdominal computed tomography scan in pediatric blunt abdominal trauma.
The purpose of this study was to evaluate the role of abdominal CT scans in pediatric patients and correlate the findings with the clinical examination. A 2-year retrospective review of 88 patients with an abdominal CT scan after blunt trauma was performed. Seventy-two patients were identified with complete clinical examination data available. ⋯ No patient with a soft, nontender abdomen and a negative CT scan required an abdominal operation. We conclude that the CT scan alone may miss clinically significant injuries. In blunt abdominal trauma in the pediatric population, the CT scan findings should be coupled with the clinical examination to ensure that no significant abdominal injuries are missed.
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The American surgeon · Oct 1999
The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction.
Accurate diagnosis and treatment of small bowel obstruction (SBO) is critical to prevent complications and reduce costs. The purpose of the current study was to evaluate the evolving role of CT scan for patients with suspected SBO and compare its sensitivity and specificity with plain abdominal films. We identified 108 patients over a 1-year period with an admission or discharge diagnosis of SBO. ⋯ CT was able to correctly identify partial or complete SBO in 35 of 38 patients (sensitivity, 92%) and correctly identified the lack of obstruction in 8 of 13 patients (specificity, 71%). These data document that plain films are a less sensitive and less specific method of diagnosing SBO and confirm that the use of CT scan is a valuable modality. CT scan should be considered for use as the primary test for patients with suspected SBO.