The American surgeon
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Forty-eight patients over 60 years of age who had sustained blunt chest trauma were evaluated by injury, treatment, survival, and return to preinjury function. The patients ranged in age from 60-92 years (mean 72). The cause of injury was a fall in 25 (52.1%) and motor vehicle accident in 20 (41.7%). ⋯ Most elderly patients who sustain blunt chest trauma will be able to return to an independent life. Nonventilatory therapy, where indicated, is preferred to reduce severe pulmonary complications. Antecedent nutritional depletion may indicate the need for ventilatory therapy in the elderly chest trauma patient.
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The American surgeon · Nov 1985
Case ReportsHepaticoduodenal fistula: an unusual complication of cholecystectomy.
This report appears to be the first documented post-cholecystectomy hepaticoduodenal fistula successfully corrected. This complication may be prevented by interposing the omentum between the liver and the duodenum at the time of any operation on the biliary system and the duodenum.
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A community experience with entericovesical fistulas is presented as well as a review of the literature. The series of 16 cases illustrates that this complication continues to present challenges in diagnosis and treatment. ⋯ When multiple stages are required, the two-stage approach is recommended. Familiarity with the proper treatment and a greater index of suspicion for this complication will lead to more acceptable management of patients with entericovesical fistulas.
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The American surgeon · Aug 1985
The use of barium enema in the evaluation of patients with possible appendicitis.
Patients with right lower quadrant pain and possible appendicitis may present a difficult diagnostic dilemma to the surgeon. Barium enema has been used as an adjunctive test in the evaluation of patients with right lower quadrant pain in whom the diagnosis is unclear. The authors retrospectively reviewed their experience with 33 patients to determine the value of barium enema. ⋯ Of five patients with normal appendices on barium enema, one patient had a diverticular abscess and underwent operation, and another patient had Meckel's diverticulitis which was excised. Barium enema can provide information to aid in the management of patients in whom the diagnosis of appendicitis is not clear. It can prevent unnecessary operation in some, and assist in earlier operation in others.
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Serum albumin and absolute hepatic albumin synthetic rates were measured in ten seriously ill injured and septic patients using the (14C) carbonate technique. Although it is commonly believed that serum albumin levels (SAL) reflect hepatic function and visceral protein status in hospitalized patients, no relationship was found between these two measured parameters in this patient population. ⋯ No significant mean SAL and albumin synthetic rate differences were noted between injured nonseptic and septic patient populations. Since albumin synthesis was elevated in most of these stressed patients these findings support the view that extravascular protein redistribution and/or increased peripheral catabolism are the major factors responsible for hypoalbuminemia in critically ill patients.