American journal of surgery
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Surgical care in the case of traumatic injury to the colon has changed significantly. During World War II, diversion was dictum. Current trends favor primary repair. ⋯ The emerging dictum for traumatic colon injuries is primary repair. Questions remain as to whether primary repair is the safest option for all colon injuries. The PATI score, CIS grade, and multiple other factors should be included in the decision making algorithm with an emphasis on primary repair.
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Comparative Study
Continuous intra-abdominal pressure measurement technique.
Abdominal compartment syndrome can develop within 12 hours of intensive care unit (ICU) admission in high-risk (shock/trauma, burn, pancreatitis, postabdominal aortic surgery) patients. The current standard of intra-abdominal pressure (IAP) measurement via the urinary catheter is labor intensive, and its intermittent nature could prevent timely recognition of significant changes in IAP. We propose that continuous IAP (CIAP) can be accurately measured via the irrigation port of a three-way catheter and has good agreement with the standard intermittent IAP (IIAP). ⋯ CIAP measurement with a three-way urinary catheter is a simple and accurate method for monitoring IAP. It has an excellent agreement with the IIAP over wide pressure ranges and should replace the current labor-intensive intermittent technique.
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Human immunodeficiency virus (HIV) infection is known to cause acquired immune deficiency syndrome, which has been associated with a wide array of cardiovascular pathologies. This report examined the clinical outcome of patients infected with HIV who underwent abdominal aortic reconstruction for aneurysm or occlusive disease. ⋯ Perioperative morbidity and mortality rates are high in HIV patients undergoing an abdominal aortic operation. Low CD4 lymphocyte counts and hypoalbuminemia are associated with poor clinical outcomes in HIV patients undergoing abdominal aortic reconstruction.
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Rhabdomyolysis accounts for up to 28% of the causes of posttraumatic acute renal failure requiring dialysis. Clinically significant rhabdomyolysis is poorly characterized biochemically and difficult to diagnose. ⋯ An algorithm for testing at-risk surgical patients was developed and may aid in the early diagnosis of clinically significant rhabdomyolysis.
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Comparative Study
Selective clinical management of anterior abdominal stab wounds.
The optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective. ⋯ Patients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.