The American surgeon
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The American surgeon · Apr 1997
Biography Historical ArticleThe first successful closure of a laceration of the pericardium.
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The American surgeon · Apr 1997
Case ReportsSpontaneous migration of subcutaneous central venous catheters.
Along with the increasing use of central venous catheters have come an increasing number of complications. Although many are discovered at the time of insertion, others can occur at a later time. If unrecognized, problems may ensue. ⋯ Migration of a central venous catheter can lead to a number of cardiovascular, neurologic, and infectious complications. Although a number of methods of nonoperative intervention have been used to correct the position of central venous catheters, it is difficult to fix a subcutaneous port, because the entire device is implanted under the skin. Removal and replacement are usually required, especially if the catheter is not in the ideal location after initial placement.
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Blunt popliteal artery trauma is a challenging injury, particularly when associated with major soft tissue damage. We reviewed our experience with this injury to determine 1) the incidence of vascular injury associated with fractures and/or dislocations about the knee, 2) the incidence of limb loss, and 3) factors associated with amputation. We treated 37 patients with 38 blunt popliteal artery injuries and either fractures about the knee or posterior knee dislocations. ⋯ The overall 9 per cent rate of positive angiograms suggests that a selective approach may be indicated. The amputation rate remains high, but it has improved with an integrated, multidisciplinary team approach. In patients without a pulse or Doppler signal and with severe soft tissue injuries, primary amputation may be appropriate.
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The American surgeon · Mar 1997
Coagulopathy in severe closed head injury: is empiric therapy warranted?
Closed head injuries account for a significant portion of the morbidity and mortality following blunt trauma. Severe closed head injuries can be complicated by the development of a coagulopathy that may worsen blood loss and delay invasive neurosurgical procedures. Awaiting the results of coagulation studies prior to initiating treatment of such a coagulopathy introduces an inherent delay that may allow worsening of the coagulation disturbance and negatively influence outcome. ⋯ We conclude that patients with closed head injuries who present with a GCS of 6 or less are candidates for empiric treatment for coagulopathy. Such treatment will negate the delay of awaiting coagulation studies. Whether or not such therapy shortens the interval between admission and neurosurgical procedures or alters outcome will require prospective study.
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The American surgeon · Feb 1997
Comparative StudyThe role of ultrasonography in blunt abdominal trauma: a prospective study.
The evaluation of blunt abdominal trauma (BAT) can be difficult because of the subtle manifestations of the injuries and because assessment is hampered by altered neurologic status. Short of laparotomy, CT and diagnostic peritoneal lavage provided the best means of accurately diagnosing intra-abdominal injury. Ultrasound (US) has recently been introduced into trauma centers in the United States as a quick, cheap, and safe method to make the diagnosis of BAT. ⋯ Overall, US was 88 per cent sensitive, 98 per cent specific, and 96 per cent accurate in diagnosing intra-abdominal injuries. There were no operative sequelae to patients whose injury was missed by US. We conclude that: 1) US can be used as the initial method of diagnosis of BAT and 2) surgeons are able to perform the examination accurately.