The American surgeon
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The American surgeon · Feb 1994
A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures.
During an 18-month study period, 100 noncardiac surgical complications of a percutaneous cardiac interventional procedure were treated at Emory University Hospital. These were predominantly pseudoaneurysms (61.2%), groin hematomas (11.2%) arteriovenous fistulae (10.2%), and external bleeding (6.1%). Less common complications included retroperitoneal hematomas (5.1%), arterial thromboses (3.1%), groin abscess (2.0%), and a mycotic pseudoaneurysm (1.0%). ⋯ Mean hospital stay after the procedure was 3.2 days. Morbidity of surgical repair was 21 per cent and mortality was 2.1 per cent. Groin complications following percutaneous cardiac procedures are related to the type of procedure performed, female gender, and periprocedure anticoagulation.
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The American surgeon · Feb 1994
Analysis of blunt and penetrating injury of the innominate and subclavian arteries.
Injury to the innominate or subclavian artery is an uncommon but difficult management problem. Review of trauma admissions from August 1983 to August 1992 revealed 21 patients who sustained injury to the innominate or subclavian artery. Eight patients sustained blunt trauma, while 13 patients sustained penetrating injuries. ⋯ Hospital days (28 vs 48) and ICU days (8 vs 14) were longer for survivors of penetrating injuries (P = NS). Complications were common in both groups. Innominate/subclavian artery injury remains a significant cause of mortality and morbidity.
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To determine outcome in young, healthy blunt trauma patients with isolated pulmonary contusion, and to identify factors associated with poor outcome, we reviewed 6012 consecutive adult (aged 16-49) blunt trauma admissions. Ninety-four (7.9%) presented with an isolated pulmonary contusion defined by chest radiograph and Injury Severity Score < 25; they compromise the study group. Poor outcome was defined as death, prolonged hospitalization (> 7 days), or a severe complication (pneumonia, empyema, atelectasis requiring bronchoscopy, or bronchopleural fistula). ⋯ The following clinical factors were identified as predisposing to poor outcome by univariate analysis: 1) Pulmonary contusion on admission chest radiograph (P = 0.035); 2) Three or more rib fractures (P = 0.002); 3) chest tube insertion (P = 0.010) and drainage (P = 0.020); and 4) hypoxia on admission (PO2 < 70 torr [P = .021], PaO2/FiO2 < 250 [P < 0.001]). Only PaO2/FiO2 < 250 on admission was an independent predictor of poor outcome in a multivariate analysis (P = 0.040). Our conclusion was that isolated pulmonary contusion in young, healthy patients is not associated with mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Feb 1994
Biography Historical ArticleCrawford Williamson Long and the use of ether anesthesia.
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The American surgeon · Jan 1994
A prospective reappraisal of primary repair of penetrating duodenal injuries.
Based on a retrospective analysis of 100 penetrating duodenal injuries, the role of primary repair or resection and anastomosis was assessed prospectively in 66 patients (1986-1992). Duodenal exclusion was reserved for extensive combined pancreato-duodenal injuries. Seven of the 66 patients died from extensive abdominal trauma (mean Abdominal Trauma Index, ATI 70) within 48 hours of admission. ⋯ We conclude that the vast majority of penetrating duodenal injuries should be managed by primary repair or resection and anastomosis. Complex duodenal decompression or diverticulization rarely are necessary. Complex procedures should be considered for patients with ATI > 40, Duodenal Injury Score > 12, and the presence of injury to the head of the pancreas.