The American surgeon
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The American surgeon · Oct 1989
Comparative StudyComparative accuracy of diagnostic peritoneal lavage, liver-spleen scintigraphy, and visceral angiography in blunt abdominal trauma.
Diagnostic peritoneal lavage (DPL), liver-spleen scintigraphy (LSS), and visceral angiography (VA) have been cited as useful in the evaluation of patients sustaining blunt abdominal trauma to determine the existence of injuries requiring operative intervention. We have reviewed the clinical courses of 44 patients who sustained blunt abdominal trauma and had various combinations of DPL, LSS, and VA employed in their diagnostic evaluation. The predictive value and efficiency of these tests have been compared in this group of patients. ⋯ In this group of patients who had multiple studies because of diagnostic uncertainty, DPL had the highest predictive value and the highest efficiency. LSS results did not by themselves dictate a change in management for any patient. In some patients VA was helpful in determining operative or nonoperative management.
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The American surgeon · Sep 1989
Case ReportsManagement of pediatric patients who have swallowed foreign objects.
The clinical management of children who have swallowed foreign bodies presents a great challenge for both pediatricians and pediatric surgeons. Our 7-year experience of treating 141 patients with a history of foreign body ingestion is reported. In 114 patients, there were 122 foreign bodies present in areas from the esophagus to the rectum, as located by plain chest and abdominal x-ray examination. ⋯ Twenty four coins in the stomach were managed conservatively. Surgical intervention was required in two patients; one patient had a previous history of pyloromyotomy, and a magnet tag measuring 1.5 cm in diameter did not pass through the pylorus for 7 weeks. The other patient had swallowed a sewing needle that moved into the descending colon and abdominal pain ensued.
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The American surgeon · Jul 1989
Comparative StudyPreventable deaths in a self-designated trauma system.
Organized paramedic care was established in 1974 in Hillsborough County, Florida, with subsequent development of a hospital self-designation system for trauma in 1980. To evaluate the level of trauma care in the county, a review of trauma deaths in 1984 was performed. A total of 452 trauma deaths was identified. ⋯ Eleven deaths (79%) were due to delay to the OR, 2 deaths (14%) were due to inadequate resuscitation, and 1 death (7%) was due to lack of surgical intervention. This study demonstrates that a self-designation system without regulatory control results in a high percentage of preventable trauma deaths. We conclude that established trauma systems are needed in all areas, including those that have had organized prehospital and hospital levels of care.
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Without surgical treatment, pancreatic abscess remains a highly lethal complication of acute pancreatitis. Many surgical series have reported mortality rates of 32 to 65 per cent in treated cases. Although pancreatic abscess is a rare condition, it is more common in patients with severe pancreatitis. ⋯ In 12 cases this procedure was combined with other surgical interventions. The recorded mortality rate was 16.66 per cent. Factors adversely affecting survival include: 1) severity of precipitating pancreatitis; 2) difficulty in making early and accurate diagnosis of the pancreatic abscess; 3) marked tendency for recurrence of sepsis; and 4) life-threatening associated complications and/or diseases.
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The American surgeon · Jun 1989
Outcome of trauma patients who present to the operating room with hypotension.
The case records of 101 patients with trauma who presented to the operating room (OR) for emergency surgery and had a systolic blood pressure (sBP) less than 90 mm Hg over a period of 3 years were reviewed. The sBP was 70-89 mm Hg in 47 patients, 50-69 mm Hg in 19 patients, and unobtainable in 35 patients. The mortality rates for these three groups were 6 per cent, 79 per cent, and 86 per cent, respectively. ⋯ Nineteen (45%) of these 42 patients responded favorably to aortic cross-clamping with a sustained increase in sBP to greater than 90 mm Hg within 5 minutes. Of these 19 patients, 42 per cent survived. The 23 patients who did not respond to aortic cross-clamping died in the OR.(ABSTRACT TRUNCATED AT 250 WORDS)