Arch Surg Chicago
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This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. ⋯ Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.
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The accuracy of peritoneal lavage in patients with gunshot wounds has not been previously reported. A prospective study comprised of 168 patients was designed to determine the reliability of physical examination and peritoneal lavage. Patients sustaining gunshot wounds to the lower chest and abdomen underwent clinical assessment followed up by lavage prior to operation. ⋯ Six of 15 patients with false-negative lavage results had RBC counts less than 1,000/cu mm. Gunshot wounds differ from stab wounds because of the unpredictable trajectory, blast effect, and high likelihood of visceral injury. It can be concluded from this study that because of the inconsistent results of both lavage and physical examination, patients who sustain gunshot wounds are best treated by exploratory celiotomy.
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Thrombotic occlusion remains a major cause of central venous catheter removal prior to completion of therapy. Injection of a dilute solution of a potent fibrinolytic agent, urokinase or streptokinase, into the occluded Silastic central venous catheter consistently reestablishes its patency. This procedure was performed on 352 occluded silicone elastomer central venous catheters with only one failure and one minor complication. We recommend this technique for restoring patency of occluded silicone elastomer central venous catheters.
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The bacteriology of the operating room with the use of the helmet-aspirator system has been discussed. The surgical team predictably contaminates the operating room. ⋯ These are commercially available and their use has been shown to decrease colony-forming particles, decrease wound contamination, and decrease wound infection. Barrier draping of the surgical team through the helmet-aspirator system is effective and is to be recommended for infection-prone cases.
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Cases of motor vehicle trauma victims who died after arrival at a hospital were evaluated in both Orange County (90 cases) and in San Francisco County (92 cases), Calif. All victims in San Francisco County were brought to a single trauma center, while in Orange County they were transported to the closest receiving hospital. ⋯ Trauma victims in Orange County were younger on the average, and the magnitude of their injuries was less than for victims in the San Francisco County. We suggest that survival rates for major trauma can be improved by an organized system of trauma care that includes the resources of a trauma center.