The American surgeon
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The American surgeon · Jan 1998
Method of urinary diversion in nonurethral traumatic bladder injuries: retrospective analysis of 70 cases.
Management of intraperitoneal, nonurethral bladder injuries by urinary diversion using suprapubic (SP) catheters versus transurethral (TU) Foley catheters was examined retrospectively in a attempt to determine which were most effective. A total of 8500 trauma admissions (6/89-1/96) were screened for bladder injuries. Mechanism, degree, treatment, and morbidity of injury in association with SP or TU Foley catheter placement were evaluated. ⋯ No urethral strictures, urinary tract infections, or retention occurred in isolated bladder injuries treated with TU catheters alone. Average SP and TU catheter duration was 42 and 13 days, respectively. TU catheters for management of blunt and penetrating bladder trauma are effective, cause fewer strictures and less morbidity, and may be removed more rapidly than SP catheters for any degree of bladder injury.
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The American surgeon · Dec 1997
Comparative StudyProlonged abdominal packing for trauma is associated with increased morbidity and mortality.
Abdominal packing and planned reoperation is a lifesaving technique for temporary control of hemorrhage in severely injured patients. Morbidity and mortality in this group of patients, however, remain significant. It is unclear whether the duration of packing impacts upon outcome. ⋯ The differences in abscess rate and mortality were statistically significant (P < 0.05). The Abdominal Trauma Index and mechanism of injury were similar for the two groups. Based on these results, we conclude that although abdominal packing is a useful technique in the severely injured patient, it is associated with greater morbidity and mortality when the duration of packing exceeds 72 hours.
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The American surgeon · Dec 1997
Vacuum pack technique of temporary abdominal closure: a four-year experience.
The purpose of this review is to present a 4-year experience with the vacuum pack technique of temporary abdominal closure. From April 1992 to December 1996, 171 vacuum packs were performed on 93 patients. Eighty-seven vacuum packs were performed on 38 general surgical patients, and 84 vacuum packs were performed on 55 trauma patients. ⋯ Management of the complicated intra-abdominal process is discussed: 1) the decision to manage the abdomen in an open fashion; 2) which method of temporary closure to use; 3) subsequent explorations; 4) when the abdomen should be closed; 5) which type of closure to use; and 6) when the abdominal wall should be revised (herniorrhaphy). The vacuum pack is the method of choice for open abdomen management and temporary abdominal closure at our institution. With careful subsequent management, good patient outcome can be achieved.
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The American surgeon · Nov 1997
Comparative StudyHeparin versus citrate regional anticoagulation during autotransfusion in a porcine intra-abdominal hemorrhage model.
Our objective was to determine the effects of anticoagulants and blood loss on hemodynamic, hematologic, and coagulation parameters following autotransfusion in an animal model of intraabdominal hemorrhage. We performed a prospective, randomized observational animal study at an animal research laboratory at a university medical center. Eight Landrace, domestic pigs, weighing 17-23 kg, each underwent jugular venous and iliac arterial catheterization and laparotomy with retroperitoneal dissection for aortic exposure to simulate an operative environment. ⋯ The decrease in concentration of each variable was independent of the choice of anticoagulant with the exception of antithrombin III, with higher levels noted in animals receiving blood anticoagulated with acid-citrate-dextrose. Prothrombin time and partial thromboplastin time were unaffected by volume of autologous transfusion or choice of anticoagulant. We conclude that changes in hemodynamic, hematologic, and coagulation parameters associated with hemorrhage and autotransfusion appear related more to the volume of blood loss and the cumulative pheresis of plasma than to the choice of anticoagulant.
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The American surgeon · Nov 1997
Case ReportsThe etiology of the adult indirect inguinal hernia: revisited.
It has generally been historically stated that indirect inguinal hernias develop only in patients who have a patient processus vaginalis that enlarges to become a hernia sac. Occasionally, this theory has been challenged but without any objective evidence. Herniography was performed by placing 50 mL of nonionic contrast material into the peritoneal cavity. ⋯ At the time of operation, an indirect sac of moderate size was present. A mesh plug repair was performed. This case report is the first published objective evidence that, contrary to common thought, a patent processus vaginalis is not a necessary prerequisite to the development of an indirect inguinal hernia.