J Trauma
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Injuries of the inferior vena cava (IVC) require prompt and definitive action. To evaluate our current management strategy, we reviewed 38 patients with IVC trauma treated from 1983 through 1990. Sixteen were injured by gunshots, eight by stabs, and 14 by blunt mechanisms. ⋯ We conclude that inferior vena caval injury remains a highly lethal injury. Successful outcome depends on prompt volume restoration, a stratified selective management approach, and avoidance of hypothermia. Prosthetic vena caval reconstruction represents an acceptable alternative.
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The purpose of this study was to examine the financial impact of assault-related penetrating trauma. We specifically reviewed hospital charges and reimbursement data. Two hundred eleven patients were identified from our Trauma Registry in a 4-year period: 108 with firearm injuries and 103 with injuries related to cutting or piercing instruments. ⋯ Financial losses incurred by community hospitals from the care of penetrating injuries are substantial, and must be borne by cost shifting or other strategies. No evidence of "dumping" was found among this group of patients. The specter of injury caused by intentional violence extends beyond urban trauma centers, and has a serious negative financial impact on community trauma centers.
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To determine whether being overweight is a predisposing factor for some common fracture types caused by stumbling, slipping, and low-energy falls, the body mass index (BMI) of 4012 adult patients with acute extremity fractures requiring surgical treatment was compared with the age-specific and sex-specific BMI values obtained from a general population sample. The cross-sectional study included 317 patients with displaced fractures of the elbow joint (distal humerus, olecranon, or radial head) and 3695 patients with displaced malleolar fractures of the ankle. ⋯ Major contrasts emerged in middle-aged men with ankle fractures, the 95% CI for the mean BMI in the age group 50-59 years being 27.4-28.2 kg/m2 versus 25.7-26.3 kg/m2 in the general population. The conclusion of the study was that an increased body mass index was descriptive of patients with displaced fractures at the elbow and the ankle, and that overweight and obesity can be regarded as predisposing factors to these injuries.
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Review Case Reports
Extracorporeal membrane oxygenation in the successful treatment of traumatic adult respiratory distress syndrome: case report and review.
We present the case of a 25-year-old, 28-week pregnant woman with two gunshot wounds to the chest. Extracorporeal membrane oxygenation (ECMO) was begun within 12 hours, despite poor results in prior studies and the need for anticoagulation postoperatively, since oxygenation was rapidly deteriorating despite aggressive treatment. The patient ultimately made a full recovery.
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Lumbar hernia is an uncommon abdominal wall hernia. Acute abdominal wall hernias, particularly lumbar hernias, are a rare complication of trauma. ⋯ Double-contrast CT scan detected herniation of bowel through an 8-cm right flank defect, which was surgically repaired with a prosthetic patch and omentopexy. In cases of acute traumatic lumbar hernia, immediate exploratory laparotomy with primary repair (when feasible) is recommended.