The Surgical clinics of North America
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Originally thought to be a rare occurrence, blunt cerebrovascular injuries (BCVIs) are now diagnosed in approximately 1% of blunt trauma patients. Early imaging of patients has resulted in the diagnosis of BCVIs during the asymptomatic phase, thus allowing prompt treatment. Although the ideal regimen of antithrombotic therapy has yet to be determined, treatment with either antiplatelet agents or anticoagulation has been shown to markedly reduce BCVI-related stroke rate. BCVIs are rare, potentially devastating injuries; appropriate imaging in high-risk patients should be performed and prompt treatment initiated to prevent ischemic neurologic events.
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Cervical spine injury can be excluded by clinical examination, without the need for radiographic study, in many patients. For those who require study, computed tomography of the cervical spine with sagittal and coronal reconstruction is the best modality for both screening and diagnosing cervical spine injury. Optimal evaluation of the obtunded patient remains controversial.
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Acute appendicitis is a common surgical emergency and the diagnosis can often be made clinically; however, many patients present with atypical findings. For these patients, there are multiple imaging modalities available to aid in the diagnosis of suspected appendicitis in an effort to avoid a negative appendectomy. ⋯ Magnetic resonance imaging is recommended when ultrasonography is inconclusive. Appropriate use of these imaging studies avoids delays in treatment, prolonged hospitalization, and unnecessary surgery.
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Surg. Clin. North Am. · Dec 2010
ReviewActive wound coverings: bioengineered skin and dermal substitutes.
Extensive skin loss and chronic wounds present a significant challenge to the clinician. With increased understanding of wound healing, cell biology, and cell culture techniques, various synthetic dressings and bioengineered skin substitutes have been developed. These materials can protect the wound, increase healing, provide overall wound coverage, and improve patient care. The ideal skin substitute may soon become a reality.
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This article addresses several distinct but related pulmonary conditions that are commonly referred to general thoracic surgeons for decision making and management. The management of various types of pneumothorax is reviewed, with particular attention to the selection of the appropriate level of surgical intervention. The related entities of bullous lung disease and diffuse emphysema are discussed, with a focus on the identification of appropriate circumstances for surgical intervention. The summarized work and the treatment recommendations are supported with an extensive bibliography of important work in this area.