Arch Surg Chicago
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Comparative Study
Trauma deaths in a mature urban vs rural trauma system. A comparison.
To compare the timing, severity, and injury characteristics of patients dying from trauma in an urban vs a rural setting. ⋯ Patients who die in a rural area without a formal trauma system are more likely to die at the scene, are less severely injured, and are older. Rural trauma patients who are admitted to a hospital and who survived for at least 24 hours before dying are older, less severely injured, have significantly more comorbidities, and are more likely to die of multisystem organ dysfunction than their urban counterparts. These differences reflect the different patient populations and injury patterns that confront urban and rural trauma centers. The higher proportion of scene deaths in the rural environment may reflect the longer discovery and transport times that occur in a rural setting.
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To determine the incidence, clinical presentation, and outcome and confounding factors associated with the development of a brain abscess in solid organ transplant recipients. ⋯ The epidemiological features of brain abscess formation after solid organ transplantation suggest 2 populations of patients exist that differ in timing, clinical setting, and response to therapy. For the chronically immunosuppressed outpatient, an established abscess should be empirically treated with sulfonamides until tissue diagnosis is confirmed. On the other hand, the acutely immunosuppressed posttransplant recipient, with defined risk factors, should receive full-dose therapy with amphotericin B and concomitantly lowered immunosuppression.
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To evaluate the effects of pneumoperitoneum with carbon dioxide, argon, and helium; different abdominal pressures (ie, 8, 12, and 16 mm Hg); and different positions (ie, head up, head down, supine) on hemodynamic and respiratory function in a porcine model. ⋯ Helium may be an alternative gas to establish pneumoperitoneum because it does not have any effect on respiratory function and has only a moderate effect on hemodynamic function. Argon insufflation has some hemodynamic disadvantages. An intraperitoneal pressure greater than 12 mm Hg and a head-up position should be avoided because both have a markedly negative effect on respiratory and hemodynamic factors.
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To investigate the role of selective nonoperative management of gunshot wounds to the abdomen. ⋯ In the appropriate environment, many civilian abdominal gunshot wounds can be managed non-operatively.
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Oxygen radicals may play an important role in injury due to thermal burns. High-dose antioxidant ascorbic acid (vitamin C, Cenolete, Abbott Laboratory, Abbott Park, Ill) therapy reduces edema of burned and unburned tissue, lipid peroxidation, and subsequent resuscitation fluid volume requirement in experimental burn models. ⋯ With delayed initiation of high-dose ascorbic acid therapy, the 24-hour fluid resuscitation volume was reduced to 32.5% of the Parkland formula, while maintaining adequate cardiac output values.