Arch Surg Chicago
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The response of the United States to a perceived terrorist threat is dichotomous. The hyperbole and exaggeration often displayed by the media and general public lies in stark contrast to the relative indifference with which terrorism is regarded by the medical community. ⋯ We will then outline recommendations for modest changes in our disaster medical planning to better prepare for these threats. Special attention will be directed at the emergence of nonconventional weapon use by terrorist organizations and how this might affect the civilian medical community.
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To test the hypothesis that guns have become the weapon of choice for assaults and that both assailants and victims have become progressively younger. ⋯ The incidence of penetrating trauma has increased in both absolute numbers and in relative proportion to blunt trauma. Firearms have become the weapon of choice and the single largest group of assailants are 11 to 20 years of age. The use of concurrent police and trauma center databases provides a more cogent basis for developing effective violence prevention strategies.
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The prognosis of colon cancer is poorest in cases of emergency presentation of this disease in the elderly. The high rate of clinical mortality in this group of patients has made it necessary to devise a specific therapeutic approach. ⋯ The lower mortality rate following primary resection is achieved by preselection of patients. The preselection is such that patients in poor general condition who have tumors in advanced stages are not treated by resection. The significantly (P = .03) highest postoperative mortality rate in patients who underwent primary resection after tumor perforation reflects the necessity of resection in those cases regardless of higher comorbidity. In an emergency situation, initial minimal surgery followed by staged resection is a feasible alternative to treat aged patients with a higher comorbidity and an intraoperatively established greater spread of tumor. This procedure permits delayed radical resection at the lowest rate of clinical mortality for this age group and is especially suitable for frail, aged patients in poor condition. The advantages of staged resection can be demonstrated by the fact that more patients with a higher comorbidity survive. The poor physiological adaptability of elderly patients limits their ability to compensate for postoperative organ failure and adds the risk of comorbidity. Hence, these 2 factors are associated with poor prognosis in this age group.
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Comparative Study
Planned exploration of pediatric liver transplant recipients reduces posttransplant morbidity and lowers length of hospitalization.
Pediatric liver transplantation (eg, orthotopic liver transplantation) has been associated with decreased graft survival compared with adult transplantation; this has been attributed to the increased difficulty of the procedure in small children and the increased number of technical variants that have been used to increase the supply of small livers. ⋯ In this series, early identification and repair of surgical problems in asymptomatic patients on day 7 significantly decreased the hospital stay and morbid consequences of surgical problems. This aggressive approach may improve overall graft and patient survival.
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Comparative Study
Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure.
To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma justifies the use of absorbable mesh prosthesis closure in severely injured patients. ⋯ The use of absorbable mesh prosthesis closure in severely injured patients undergoing celiotomy was effective in treating and preventing the abdominal compartment syndrome.