The American surgeon
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Retrospective chart analysis was carried out on 13 patients presenting to the trauma service at the Humana Hospital University in Louisville, from January, 1984 through December, 1987 with a diagnosis of acute laryngeal injury. The most common cause of injury was blunt trauma suffered in a motor vehicle accident. ⋯ All 13 patients had a favorable result. The purpose of this paper is to review the findings of our study and to discuss diagnostic and management recommendations for laryngeal trauma.
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Hematuria after blunt abdominal trauma is common with multiple organ system injuries, and many trauma centers routinely perform intravenous pyelography (IVP) on all trauma patients having any degree of hematuria. However, it has been suggested that many IVPs could be avoided if more selective criteria were used. To help determine the need for an IVP, we reviewed the records of 102 consecutive patients undergoing IVP after blunt abdominal trauma over a 17-month period. ⋯ Thus, if IVP had been performed only when gross hematuria was present, then all surgically significant urinary tract lesions would have been recognized, and 75 per cent of these 102 patients would have been spared IVPs. We agree with others that microscopic hematuria alone is not an indication for emergency IVP in these trauma patients. However, gross hematuria or other strong clinical evidence of renal injury still mandates IVP early during the assessment of patients who have suffered blunt abdominal trauma.
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Enteral nutrition is best delivered via a small bore feeding tube whose tip lies in the proximal jejunum. A major obstacle to tube placement is the lack of a reliable means of assuring passage through the pylorus. A simple, quick method of tube placement using endoscopic assistance that was successful in 18 of 20 (90%) attempts is described.
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The American surgeon · Dec 1988
Delayed immune dysfunction following hemorrhagic shock and resuscitation.
Immune system function is thought to be depressed after hemorrhagic shock. We evaluated the delayed effect of hemorrhagic shock on the immune system in rats with and without spleens and investigated the effect of the colloid hetastarch on reticuloendothelial system (RES) function. There were six groups: controls (N = 30, no shock), two groups of shocked animals resuscitated with either hetastarch (HES, N = 13) or lactated Ringer's (LR, N = 13); the remaining three groups were identical except that splenectomy had been performed (N = 16, N = 14, and N = 16, respectively). ⋯ These data demonstrate that delayed immune function is depressed in nonsplenectomized rats. Splenectomy causes more severe immune dysfunction than does shock. Also, in similar animals without splenectomy, hetastarch does not appear to alter delayed RES function.
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The American surgeon · Nov 1988
Review Case ReportsTraumatic abdominal hernia: a case report and review of the literature.
Traumatic abdominal hernia remains a rare clinical entity despite an overall increase in blunt abdominal trauma. What appears to be the most extensive traumatic abdominal hernia so far described is presented. Traumatic abdominal herniae fall into three general categories: small lower quadrant abdominal defects and inguinal hernias, typically the result of blunt trauma with bicycle handlebars, are the most common; larger abdominal wall defects sustained in motor vehicle accidents are the next most common hernias; intra-abdominal herniations through rents in the retroperitoneum are rarely seen. ⋯ Conventional radiology, computerized tomography, and ultrasound have also proven useful. Because of the high incidence of other associated intra-abdominal injuries, early exploration and repair through a midline incision is advocated. Adequate debridement and solid repair of fascial planes with non-absorbable sutures are required to prevent recurrence.