Journal of the American College of Surgeons
-
Comparative Study
Terror-related injuries: a comparison of gunshot wounds versus secondary-fragments-induced injuries from explosives.
Terror-related injuries caused by secondary fragments (SF) from explosive devices show a distinctive pattern in severity, distribution, outcomes of assault, and health-system resource use as compared with terror-related penetrating injuries caused by gunshot wounds. ⋯ Terror victims suffering from SF wounds have more complex, widespread, and severe injuries than victims suffering from gunshot wounds. They tend to involve multiple body regions and use more in-hospital resources. Attenuation of bus seats and protective vests can lead to a reduction in severity of these injuries.
-
Comparative Study
Operative management and outcomes of traumatic lung resection.
To analyze the presentation, injury patterns, and outcomes among a large cohort of patients requiring lung resection for trauma, and to compare outcomes stratified by the extent of resection. ⋯ Lung resection is infrequently required for traumatic injury, but carries substantial associated morbidity and mortality. The extent of lung resection is an independent predictor of hospital mortality, even after exclusion of patients with severe associated injuries. The worst outcomes were seen after complete pneumonectomy.
-
Because herniorrhaphy failure and complication rates appear proportional to the number of previous repairs, multiply recurrent hernias (MRH) represent a formidable challenge. We sought to determine the safety and efficacy of open preperitoneal retrofascial mesh repair of MRH. ⋯ Open preperitoneal retrofascial mesh repair resulted in an effective herniorrhaphy with low perioperative morbidity in patients with MRH. Smoking cessation appears to be important in minimizing infectious complications. Given the technical challenge, surgical care of patients with MRH may be best provided in referral centers with interest and expertise in complex hernia repairs.
-
Comparative Study
An ethanol protocol to prevent alcohol withdrawal syndrome.
Alcohol withdrawal syndrome (AWS) occurs in dependent patients during the initial period of sudden onset abstinence. It is usually manifested by mild symptoms such as disorientation, agitation, and tachycardia, but, if untreated, can lead to severe confusion, seizures, and even cardiovascular collapse. Prevention of AWS has been shown to improve morbidity and mortality and shorten hospital and ICU stays. We examined the efficacy of ethanol as a method of prophylaxis. ⋯ Intravenous ethanol is a viable option for AWS prophylaxis when administered in a systematic protocol.
-
Comment Letter Comparative Study
Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers.