The American surgeon
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The American surgeon · Jul 1994
Comparative StudyPrimary repair of colon injuries: a retrospective analysis.
Primary repair, or resection and anastomosis, should be considered for treatment of all civilian patients with penetrating colon injuries. During the past six years, 154 patients with colon injuries (excluding rectal injuries) were treated in an urban trauma center. Primary repair, including resection and anastomosis, was performed in 102 patients (66%) and diversion in 52 patients (34%). ⋯ Associated risk factors were not useful in predicting an increase in morbidity and mortality in either group. However, PATI had greater predictive value for determining morbidity and mortality than did CIS. Primary repair or resection and anastomosis should be considered for treatment of all penetrating colon injuries excluding rectal injuries.
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The American surgeon · Jul 1994
Predictors of positive CT scans in the trauma patient with minor head injury.
Routine cerebral CT scanning of patients with minor head injuries has been advocated as a screening procedure for hospital admission. The purpose of this study was to determine whether there were characteristics of the trauma patient with a minor head injury. Glasgow Coma Scale (GCS) of 13-15, that would predict a positive cerebral CT scan. ⋯ Of the nine patients who sustained a skull fracture, five had a positive CT (55.6%; 95% confidence interval 21.2% to 86.3%) (P < 0.0001). Of all the patients with positive CT scans, two underwent emergent craniotomy: one for a depressed skull fracture with underlying contusion, the other for a temporal bone fracture and an epidural hematoma. Both patients had LOC and SC-GCS and ER-GCS of 15.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Jul 1994
Morbidity after intraperitoneal insertion of saline-filled tissue expanders for small bowel exclusion from radiotherapy treatment fields: a prospective four year experience with 34 patients.
When prolonged small bowel exclusion (SBE) from external radiotherapy (RT) fields or immediate exclusion of bowel from brachytherapy sources is required for a patient without adequate omentum, there are no simple proven methods available for accomplishing these goals. We report a prospective study of SBE by intraperitoneal, saline-filled tissue expanders (TE). Thirty-four patients had exclusion of small bowel from either external radiotherapy (RT) ports (20), afterloading catheter treatment fields (5), both (5), or from intracavitary implants (4). Twenty-seven TEs were placed in the pelvis and 7 in the iliolumbar fossa. TE volume ranged from 400-1500 cc (median 550 cc). Patients had rectal (n = 15), colon (6), endometrial (4), anal (3), and vaginal (1) cancers and sarcomas (5). Fifteen patients had recurrent neoplasms, 13 of which were in previously irradiated fields. Nine patients had colorectostomies directly behind the TE, and 12 had other bowel (6) or ureteral (3) anastomoses or bladder repairs (3) adjacent to the TE. ⋯ Intraperitoneal placement of a saline-filled tissue expander is a simple, safe and effective means of small bowel exclusion from RT portals.
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The American surgeon · Jun 1994
Comparative StudyPotential of laparoscopy to reduce non-therapeutic trauma laparotomies.
Standard diagnostic methods used to evaluate patients sustaining abdominal trauma result in non-therapeutic laparotomy rates ranging from 5 to 40 per cent depending upon the clinical situation. The purpose of this study was to assess the safety and efficacy of diagnostic laparoscopy in the identification of intra-abdominal injuries in stable trauma patients. ⋯ There were no complications related to the procedure. Emergency laparoscopy is safe and should be considered in hemodynamically stable trauma patients with indications for laparotomy based on standard diagnostic criteria in order to minimize the incidence of non-therapeutic laparotomy.
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The American surgeon · Jun 1994
Two-dimensional echocardiogram in hemodynamically stable victims of penetrating precordial trauma.
Hemodynamically stable patients with penetrating precordial trauma present a diagnostic dilemma. Previous reports utilizing subxiphoid pericardial windows as the diagnostic measure demonstrated negative rates ranging from 75-82%. In an effort to decrease the high rate of negative invasive procedures, the following study was undertaken. ⋯ Echocardiogram is a sensitive noninvasive method of evaluating hemodynamically stable victims of penetrating chest wounds in proximity to the heart.