The American surgeon
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The American surgeon · Nov 1984
The treatment of 179 blunt trauma-induced liver injuries in a statewide trauma center.
The records of 179 patients who were admitted to a statewide trauma center with liver injuries from blunt abdominal trauma are reviewed. The overall mortality for the 119 men and 60 women was 35 per cent. The simpler forms of injury (classes 1, 2, and 3) were easily treated and yielded good results, whereas treatment for major injuries, involving lobar destruction and vena caval injury (classes 4 and 5), yielded poor results. ⋯ Infection played a significant role in the deaths of 27 patients. In eight of these 27 patients, the infections were related directly to the liver injury. The number of associated injuries per patient appeared unrelated to the overall outcome of the injury.
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Retrospective analysis failed to demonstrate that drainage in routine cholecystectomy was associated with the reported incidence of wound complications. The overall complication rate was increased in those patients in whom drains were used. ⋯ Those patients who did not have drainage did not experience related problems, but drains may diagnose and treat the occasional bile leak. Incidental appendectomy increased the incidence of wound infection.
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Four cases of acute cervical abscess resulting from infection through the left piriform sinus fistula are described. The fistula seems to be related to the cause of infection in many of previously reported cases of acute suppurative thyroiditis or "recurrent lateral cervical fistula." Complete removal of the fistula is essential to a permanent cure, and the guide of a Fogarty catheter through the fistula is useful at operation for patients with repeated infection.
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The American surgeon · Jun 1984
The reasons for gastrointestinal consultation after cardiac surgery.
Sixty-two (1.10%) of 5719 patients undergoing cardiac surgery between 1976 and 1982 required postoperative gastro-intestinal consultation, and 24 (0.4%) required operation. The major complications were gastrointestinal bleeding due to gastritis in 15, peptic ulcer in ten, and acute cholecystitis in 12. Acute diverticulitis was diagnosed in eight patients. ⋯ Gastro-intestinal complications following cardiac surgery are rare but carry significant mortality. Patients with circulatory compromise and those requiring intra-aortic balloon pump are most likely to develop gastrointestinal complications. Careful monitoring and physical examination of these high-risk patients following cardiac surgery is required for early detection and effective treatment.
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Postpump pancreatitis has been described to occur in patients undergoing cardiac surgery with cardiopulmonary bypass. Twenty patients were prospectively analyzed with sera drawn for total serum amylase, pancreatic isoamylase, and nonpancreatic isoamylase levels. ⋯ No patient had clinical pancreatitis. These findings suggest that elevations of serum amylase is common after cardiopulmonary bypass and is not indicative of pancreatitis.