The American surgeon
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The American surgeon · Mar 1998
Case ReportsSuccessful management of calyceal fistula following simultaneous pancreas-kidney transplantation.
Calyceal fistula is an unusual complication of renal transplantation. We report a case of calyceal fistula after simultaneous pancreas-kidney transplant that developed after thrombosis of a lower pole artery. Surgical correction was successfully achieved with a lower pole nephrectomy, closure of the involved calyces, and placement of a ureteral stent and a pedicle of greater omentum graft over the affected parenchyma.
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The American surgeon · Feb 1998
Outcomes from abdominal aortic aneurysm resection: does surgical intensive care unit length of stay make a difference?
Recent studies indicate that surgical intensive care unit (SICU) length of stay (LOS) may be shortened without significantly compromising patient care. We tested the validity of that claim in patients following abdominal aortic aneurysm (AAA) resection, a group that traditionally mandated SICU care, to determine whether recent changes in care have affected outcomes. Severity of illness, utilization of SICU-specific resources, lengths of stay, and outcomes were measured in 295 consecutive AAA patients admitted to the SICU postoperatively over a 6-year period (1988-1994). ⋯ Over a 6-year period, SICU LOS was reduced by nearly 50 per cent in patients receiving elective AAA resections without affecting outcome, as measured by hospital LOS or mortality. Decreasing the SICU LOS was effected by transferring patients to floor care with a higher severity of illness. This change saved approximately $175,000 per year in SICU costs.
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The American surgeon · Feb 1998
Indications and complications of arterial catheter use in surgical or medical intensive care units: analysis of 4932 patients.
In critical care settings, arterial catheters (ACs) are very useful in monitoring the blood pressure and are often used for repetitive blood sampling. No studies have been performed that compare the approach and complication rates of ACs in a medical intensive care unit (MICU) to those in a surgical intensive care unit (SICU). Over a 24-month period, 3255 patients were admitted to the MICU and 1677 to the SICU of Howard University Hospital. ⋯ Arterial spasm and pulselessness were more commonly found after new-site insertion. The site of AC placement and the timing/number of catheter/site changes made no significant difference in terms of complications, which is a new finding compared to other previous reports. The rates of infection between radial and femoral artery were similar.
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The American surgeon · Jan 1998
The long-term complications of percutaneous dilatational tracheostomy.
Percutaneous dilatational tracheostomy was adopted at our institution, because it was demonstrated to be more cost effective than standard open tracheostomy in critically ill patients. The objective of this study was to evaluate the long-term outcome and complication rate of percutaneous dilatational tracheostomy in critically ill patients. We performed a consecutive case study of all Level I trauma patients from August 1991 to May 1994 who underwent percutaneous dilatational tracheostomy. ⋯ Of the study group patients undergoing percutaneous dilatational tracheostomy, 27 per cent complained of symptoms a minimum of 1 year posttracheostomy. Of these patients, 60 per cent underwent fiberoptic laryngoscopy, and no subglottic lesions were identified. Our findings suggest that percutaneous dilatational tracheostomy is a safe, cost-effective alternative to standard tracheostomy in critically ill patients.
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The American surgeon · Jan 1998
Method of urinary diversion in nonurethral traumatic bladder injuries: retrospective analysis of 70 cases.
Management of intraperitoneal, nonurethral bladder injuries by urinary diversion using suprapubic (SP) catheters versus transurethral (TU) Foley catheters was examined retrospectively in a attempt to determine which were most effective. A total of 8500 trauma admissions (6/89-1/96) were screened for bladder injuries. Mechanism, degree, treatment, and morbidity of injury in association with SP or TU Foley catheter placement were evaluated. ⋯ No urethral strictures, urinary tract infections, or retention occurred in isolated bladder injuries treated with TU catheters alone. Average SP and TU catheter duration was 42 and 13 days, respectively. TU catheters for management of blunt and penetrating bladder trauma are effective, cause fewer strictures and less morbidity, and may be removed more rapidly than SP catheters for any degree of bladder injury.