The American surgeon
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Bullet embolus is a rare complication of penetrating missile injury in children with only a handful of case reports. We describe a seven year old with a venous bullet embolus to the right ventricle.
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The objective of this study was to investigate the prevalence of incidental findings in pan-computed tomography (CT) scans of trauma patients and the communication of significant findings requiring follow-up to the patient. A retrospective chart review of adult trauma patients was performed during the period of January 1, 2011, to August 31, 2011. During that period, 990 patient charts were examined and 555 charts were selected based on the inclusion criteria of a pan-CT scan including the head, neck, abdomen/pelvis, and chest. ⋯ With the use of pan scans on trauma patients, many incidental findings have been identified to the benefit of the patient. The majority of these are clinically insignificant; however, only 32.6 per cent of potentially significant findings were communicated to the patient. The advantage of early detection comes from proper communication and this study demonstrates that there could be improvement in conveying findings to the patient.
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The American surgeon · Aug 2014
Trauma intensive care unit 'bouncebacks': identifying risk factors for unexpected return admission to the intensive care unit.
Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. ⋯ Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.
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The American surgeon · Aug 2014
Comparative StudyComponent separation with porcine acellular dermal reinforcement is superior to traditional bridged mesh repairs in the open repair of significant midline ventral hernia defects.
The optimal technique for complex ventral hernia repair (VHR) remains controversial. Component separation (CS) reinforced with porcine acellular dermal matrix (PADM) has shown favorable results compared with series of conventional bridged VHR, but few comparative studies exist. We conducted a retrospective cohort study comparing 40 randomly selected patients who underwent CS/PADM reinforcement against an identical number of patients who underwent conventional open VHR with mesh at our institution. ⋯ This is evidenced by lower recurrence rates and overall complications requiring reoperation, particularly mesh infection. This is despite the greater use of CS in larger defects and contaminated hernias (VHWG Grade III and IV). CS/PADM reinforcement should be strongly considered for the repair of significant midline ventral hernia defects.
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The American surgeon · Aug 2014
Moped collisions among patients with revoked drivers' licenses are a significant public health problem: a retrospective cohort study.
Many states do not require a license to operate a moped, defined as a motor vehicle with less than 50-cc engine displacement. These vehicles may therefore serve as a mode of transportation for those who are driving without a license and who may have a history of prior high-risk behavior. We hypothesized that those involved in moped collisions were more likely to have previous convictions for driving while intoxicated (DWI) and other non-DWI offenses than those on conventional motorcycles. ⋯ Moped drivers were significantly more likely to have a prior conviction of DWI as well as prior convictions of other crimes, establishing a pattern of disregard for the law. The use of these vehicles without a license likely presents a risk to public safety. Legislation to require licensing before moped operation should be considered.