The American surgeon
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The use of antibiotics for patients undergoing tube thoracostomy was determined to be highly variable based on a study conducted at a national meeting of surgeons. A meta-analysis of six randomized studies previously reported was performed. The analysis was carried out using the Confidence Profile Method software FAST*PRO. ⋯ The results of this meta-analysis suggest that antibiotics should be used in patients undergoing tube thoracostomy. Antibiotic selection should maximize therapy for Staph. aureus. The implementation of this practice guideline will require the co-operation of multiple specialty oriented physicians and surgeons.
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Pancreatic injuries from blunt trauma are infrequent, and their diagnosis and management can be extremely difficult. Over the past 10 years we treated 13 patients with major pancreatic injuries from blunt trauma. Twelve had been involved in motor vehicle collisions, none of whom were wearing seat belts. ⋯ All patients survived. The diagnosis of blunt pancreatic injury requires a high index of suspicion, and diagnostic studies may demonstrate only subtle signs of injury. Most injuries can be managed by localized resection and/or drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Feb 1995
Comparative StudyDiagnostic laparoscopy for suspected appendicitis.
One hundred consecutive patients who underwent diagnostic laparoscopy for suspected appendicitis were evaluated to assess the appropriate clinical setting for laparoscopic appendectomy. The usefulness of diagnostic laparoscopy in the setting of acute abdominal pain has been well documented. However, there is debate about the use of laparoscopy for definitive therapy. ⋯ The friability of bowel wall greatly increases the risk for bowel injury in this setting. Laparoscopy is a useful technique for the diagnosis and treatment of abdominal pain even if the appendix is normal on inspection. Conversion to an open operation should be employed when inflammation or perforation occurs at the base of the appendix and when bowel is found to be adherent to an appendiceal abscess.
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The Medical College of Georgia Level I Trauma Center admitted 5603 adult trauma patients from January 1, 1989 through June 30, 1993. Cricothyrotomy was required in 66 of 525 patients who required emergency airway control but could not be intubated nonsurgically in an expeditious manner. ⋯ No patient had clinically significant morbidity from the cricothyrotomy, whether with or without a subsequent tracheostomy. Surgical cricothyrotomy remains an important technique with low morbidity for selected trauma victims needing emergency airway control.
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Abdominal CT scanning makes nonoperative management of liver injury possible. We reviewed medical records of 56 blunt trauma patients with hepatic injury who received initial abdominal CT scan. We examined: 1) Indications for delayed surgery; 2) Disposition or cause of death; 3) Results of follow up CT scans; 4) Long term complications. ⋯ All of the CT scans showed stabilization or improvement of hepatic injury. Three patients who had CT scans taken at 3 months postdischarge were asymptomatic, with radiologic resolution of their hepatic injury. Nineteen patients were followed for an average of 61.8 days (range 7-203 days) after discharge with no complications from liver injury.(ABSTRACT TRUNCATED AT 250 WORDS)