J Trauma
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The evaluation of various techniques to diagnose or exclude ventilator-associated bacterial pneumonia has been a focus of much research. One such technique involves elastin fiber detection. It has been inferred from previous work that 40% potassium hydroxide preparations of respiratory secretions that demonstrate elastin fibers have a 100% specificity in diagnosing bacterial pneumonia in intubated, mechanically ventilated patients without acute diffuse lung injury. The purpose of this investigation was to ascertain if elastin fibers might be detected in respiratory secretions in acute, diffuse lung injury in the absence of pneumonia (i.e., assess specificity). ⋯ We concluded that seeing these results, given a true specificity of 0.99 inferred from previous work, is highly improbable with a probability of 2.74 x 10(-7). Thus, elastin fiber analysis is likely to be highly nonspecific for diagnosing pneumonia in the setting of acute diffuse lung injury.
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A case is reported of a patient who sustained a cardiac injury from a 16-penny nail fired from a nail gun and who was successfully treated at a small rural hospital.
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Case Reports
Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma: case reports.
Splenic artery pseudoaneurysms are known to be caused by either pancreatitis or operative trauma. We present two patients who had delayed presentation of splenic artery pseudoaneurysms secondary to blunt abdominal trauma. This is the first report of splenic artery pseudoaneurysms following trauma and demonstrates the importance of follow-up computed tomography scans in patients with splenic injuries who are treated nonoperatively.
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Case Reports
Lobectomy for traumatic pulmonary pseudocysts with disseminated intravascular coagulation: case report.
A 10-year-old boy was injured in a traffic accident, and computed tomography revealed cavitary pulmonary lesions in the left lower lobe. Although there was no evidence of bacterial infection, thrombocytopenia due to disseminated intravascular coagulation progressed. We performed a left lower lobectomy, and the patient improved rapidly.
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To determine if trauma patients qualifying by a 1990 American College of Surgeons (ACS) audit filter have the same outcomes and resource utilizations as similar (matching) patients not qualifying by the filter. ⋯ Additional studies of the efficacy and efficiency of trauma quality assurance filters are needed. Objective criteria should be established for the definition, evaluation, modification, and adoption of trauma audit filters.