The American surgeon
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The American surgeon · Oct 1997
The treatment of low cardiac output syndrome following cardiopulmonary bypass using delayed sternal closure.
The purpose of this study, was to ascertain whether delayed sternal closure (DSC) could eliminate the need for an intra-aortic balloon pump (IABP) or ventricular assist device (VAD) in patients with low cardiac output syndrome (LCOS) following coronary artery bypass grafting surgery (CABG). To investigate this, the records of 3014 patients undergoing CABG were retrospectively reviewed. Sixty (2.0%) patients had a relative or absolute contraindication to IABP or VAD use and required DSC for LCOS. ⋯ DSC appears to be a simple and safe method for treating LCOS following CABG. It is effective in resolving the majority of patients' LCOS without the addition of any significant morbidity. DSC also spares these patients the added morbidity, mortality, and cost associated with circulatory assist devices.
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The American surgeon · Oct 1997
Management of tracheobronchial injuries following blunt and penetrating trauma.
Disruptions of the trachea and bronchi are an infrequent but a life-threatening injury following trauma. We reviewed our experience with tracheobronchial injury from 1988 to 1996. Out of 12,789 trauma patients treated at a university Level I trauma center, 16 patients (0.13%) with tracheobronchial injuries were seen. ⋯ Nonoperative management was successful in three (19%). Early mortality was 13 per cent. A high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with tracheobronchial injuries.
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The American surgeon · Sep 1997
Factors predicting prolonged mechanical ventilation in critically injured patients: introducing a simplified quantitative risk score.
Our objective was to identify a set of readily available and easily obtainable parameters that would predict prolonged mechanical ventilation in the critically injured patient. A surgical intensive care unit of an academic Level I trauma center. Prospectively collected data were retrospectively analyzed on all critically injured patients receiving mechanical ventilation for more than 2 days between January and December 1994. ⋯ The need for an easily calculated score, which is derived from readily available parameters and can reliably identify patients with prolonged needs for ventilatory support, is obvious in the trauma setting. We describe a five-point risk score by which we can predict the need for PMV early in the course of the disease. Resource utilization and personnel allocation issues, as well as important therapeutic procedures, can be planned based on this score.
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The American surgeon · Sep 1997
Comparative StudyPrevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats.
Adhesion formation, which is almost inevitable following incisional hernia repair with prosthetic mesh, may lead to intestinal obstruction and enterocutaneous fistulae. Physical barriers, namely carboxymethylcellulose and hyaluronic acid, have been reported to lessen the intra-abdominal adhesions. To evaluate the effects of Seprafilm (Genzyme Corp., Cambridge, MA), a bioresorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, in the presence of a foreign body such as polypropylene mesh, an incisional hernia model in rats was used. ⋯ Seprafilm animals had fewer adhesions compared with control animals (P = 0.0008). Seprafilm had no adverse effect on wound healing. This membrane seems to have the potential to lessen the adhesion-related morbidity following incisional hernia repair.
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The gluteal compartment syndrome is a rare, often unrecognized condition which, left untreated, can lead to renal failure, sepsis, and death. The etiology, physiology, and manifestations are similar to those seen in the more common and readily recognized compartment syndromes of the lower leg and forearm. The large gluteal muscle mass confined by the fascia lata of the thigh and tensor fascia lata can, under the right conditions, produce muscle necrosis, acidosis, elevations of creatinine phosphokinase, and ultimately renal failure. ⋯ This prolonged compression leads to muscle damage, edema, and a full-blown compartment syndrome. Due to its anatomic location and rarity, diagnosis is missed or delayed, resulting in significant morbidity and possible mortality. The mainstay of treatment consists of fasciotomy and debridement.