Canadian journal of surgery. Journal canadien de chirurgie
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Of 1136 patients admitted consecutively to two medical-surgical intensive care units, 100 were found to have multiorgan failure, defined as failure of more than two organ systems. The average duration of stay in the intensive care units was 13.4 days. The overall death rate was 78% compared with 12.8% for patients without multiorgan failure. ⋯ Surgery during the course of multiorgan failure had neither an adverse nor beneficial effect on outcome. The mean number of organ systems failing was 4.36 for survivors and 5.03 for nonsurvivors. The most common systems to fail were central nervous, cardiovascular and respiratory.
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Injury scoring systems are used to describe groups or individuals for purposes of epidemiologic studies, quality assurance or triage. The two most widely used methods are the injury severity score (ISS) and the trauma score (TS). In this paper, the authors describe their experience with these two methods in a group of 175 severely injured children. They found both to be reliable and valid but found the ISS the more useful of the two for various practical reasons.
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Case Reports
Avulsion of the pectoralis major tendon in a weight lifter: repair using a barbed staple.
Avulsion of the pectoralis major tendon is uncommon. The usual mechanism is a sudden muscular contraction with the rupture occurring at any point between the muscle's origins on the clavicle and sternum and its tendinous insertion on the humerus. At least half the reported cases involve athletes. ⋯ Surgical correction using a barbed bone staple to reattach the tendinous portion of the pectoralis major to its attachment at the lateral lip of the bicipital groove has not previously been described. The authors obtained an excellent postoperative result in a 20-year-old competitive weight lifter who was able to return to active body-building competition. They advocate prompt surgical correction of this lesion in any active healthy person.
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Ascending aortic dissection complicated by aorta-right atrial fistula is a very rare occurrence. The patient may present with atypical clinical findings such as a continuous murmur or atrioventricular block, making the diagnosis difficult. Surgical repair is straightforward unless the correct diagnosis is missed, in which case there may be difficulties during the initial period of cardiopulmonary bypass. This report deals with the successful management of a 67-year-old man with this condition.
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Patients with empyema not responding to simple chest-tube drainage and antibiotic therapy have been managed by a "Clagett"-type procedure that consists of open-window thoracostomy, antibiotic irrigation and closure of the window. The results of such treatment were reviewed. Of the 103 patients with empyema treated between 1967 and 1983, 41 underwent open-window thoracostomy. ⋯ Unsuccessful closure resulted in chronic fistulas in four patients in each of the two groups. Six deaths in group 1 and two in group 2 were related to the original disease, but one was an operative death. These results demonstrate both the effectiveness and limitations of open-window thoracostomy in the management of these difficult cases.