The American surgeon
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The American surgeon · Nov 1998
Resource utilization in traumatic brain injury: the role of magnetic resonance imaging.
Cerebral CT scanning is routine in the acute evaluation of traumatic brain injury (TBI) patients. MRI has been reported to identify cerebral lesions better than CT scan. The purpose of this study was to determine whether MRI influenced the acute diagnosis and management of TBI patients. ⋯ The performance of MRI resulted in additional charges of $75,640 or $3,152/patient identified with a new lesion. Although MRI identifies lesions not evident on CT scan, MRI does not alter management plans and is of limited value in the acute management of TBI. MRI may be of medicolegal benefit in cases of child abuse.
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The American surgeon · Nov 1998
Intraoperative radiotherapy in the combined-modality management of pancreatic cancer.
The purpose of this study is to assess the feasibility, clinical tolerance, local control, and survival rates using a combined-modality treatment program of intraoperative radiation, chemotherapy, and external beam radiation for the management of patients with pancreatic cancer. One hundred eighty patients with biopsy-proven adenocarcinoma of the pancreas have been treated by a single surgical practice between 1979 and 1992. Of these, 105 had locally advanced but unresectable primary tumors (stages 2 and 3). ⋯ Patients with pancreatic cancer historically have poor survival and local control rates despite aggressive chemotherapy and radiation. The addition of intraoperative radiation to the combined modality management of pancreatic cancer offers markedly improved survival rates and local control with minimal morbidity for patients with unresectable disease. Intraoperative radiation in the form of IORT can be delivered with a significantly fewer complications than I-125 seed implantation.
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The American surgeon · Oct 1998
Outcomes from nonemergent orthotopic liver transplantation: is postoperative care becoming routine?
The outcome of surgical intensive care unit (SICU) care after nonemergent orthotopic liver transplantation (OLTX) was evaluated in 168 consecutive patients over a 6-year period (1/90-12/95). Prospective data collected included age, first and last SICU day Simplified Acute Physiology Score and Quantitative Therapeutic Intervention System Score, SICU length of stay (LOS), and mortality. The patient population was 61 per cent male and 39 per cent female, with ages ranging from 20 to 75 years. ⋯ Over the study period, there was no difference in severity of illness or intensity of intervention upon discharge to floor care. The decreased SICU LOS did not adversely affect patient mortality or severity of illness upon SICU discharge during the 6-year period. With intensified SICU intervention, nonemergent orthotopic liver transplantation patients can have a shorter SICU LOS without adverse effects on outcome.
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Diagnostic laparoscopy performed before laparoscopic repair of groin hernias offers an opportunity to examine all hernial orifices. This study was undertaken to evaluate the accuracy of the preoperative clinical diagnoses and to determine the frequency of unexpected groin hernias. Between December 1990 and November 1997, 253 patients (243 male) underwent laparoscopic repair of 560 hernias. ⋯ Incorrect diagnoses in 91 of 180 patients (50%) thought to have bilateral hernias included a different and/or additional type of ipsilateral inguinal hernia on either side in 63 patients (35%), a femoral hernia in 21 patients (12%), or a unilateral hernia in 7 patients (4%). Unexpected hernias that would not have been treated with an anterior approach were found in 64 patients (25%; 27 were femoral and 37 were contralateral). The laparoscopic technique allows for identification and repair of previously undiagnosed contralateral and femoral hernias at the first operation.
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The American surgeon · Oct 1998
Comparative StudyAn early comparison between endoscopic ultrasound-guided fine-needle aspiration and mediastinoscopy for diagnosis of mediastinal malignancy.
Precise mediastinal lymph node staging is essential in non-small cell lung cancer for proper evaluation and treatment. In addition to CT, mediastinoscopy is routinely used for staging and diagnosis of mediastinal malignancy. Recently, endoscopic ultrasound (EUS) combined with fine-needle aspiration (FNA) biopsy has been used to evaluate mediastinal disease. ⋯ Mediastinoscopy and EUS/FNA are highly accurate methods of staging mediastinal malignancy. Mediastinoscopy provides better access to the upper and anterior mediastinum, whereas EUS/FNA can safely be used to biopsy subcarinal and posterior mediastinal masses. Mediastinoscopy and EUS/FNA target different areas of the mediastinum and may be complimentary in the evaluation of mediastinal malignancy and staging of bronchogenic carcinoma.