The American surgeon
-
The American surgeon · Dec 2013
Does alcohol intoxication protect patients from severe injury and reduce hospital mortality? The association of alcohol consumption with the severity of injury and survival in trauma patients.
Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. ⋯ Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.
-
The American surgeon · Dec 2013
Comparative StudyComparison of the three surgical flap techniques in pilonidal sinus surgery.
We aimed to study the efficacy of three surgical flap techniques in pilonidal surgery. Pilonidal disease is characterized by chronic inflammation and infection in the sacrococcygeal region. Complications and recurrence are common after treatment and optimal treatment for the disease has not been established yet. ⋯ Patients have been treated with Karydakis (n = 113), modified Limberg (n = 179), or Limberg (n = 109) flap techniques. Mean off-work period, time to walk without pain, time to sit on the toilet, time to take the drainage catheter off, maceration rates, recurrence, and hypoesthesia rates were significantly better in the modified Limberg group. In conclusion, we showed the modified Limberg technique is superior than both Limberg and Karydakis techniques.
-
The American surgeon · Dec 2013
The impact of age on mortality in patients in extremis undergoing urgent intervention.
Trauma patients admitted without vital signs have little hope of survival even with extreme interventions. We performed this study to determine the effect of age on survival in patients in extremis undergoing urgent thoracotomy. The National Trauma Database was searched for patients presenting without a systolic blood pressure (0), a Glasgow Coma Scale score less than 8, and underwent an urgent thoracotomy. ⋯ However, neither pediatric (P = 0.418) nor older status (P = 0.184) was predictive. Age does not significantly impact mortality in patients in extremis who undergo urgent thoracotomy. Age should not be a contributing factor in determining who should undergo more extreme maneuvers if they present as a reasonable candidate using other criteria.
-
The American surgeon · Dec 2013
One-step laparoscopic and endoscopic treatment of gallbladder and common bile duct stones: our experience of the last 9 years in a retrospective study.
The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. ⋯ Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.