Arch Surg Chicago
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Review Case Reports
Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases.
Hepatic portal venous gas (HPVG) in adults is a rare entity. The underlying pathologic condition is usually an intestinal ischemia, but it has been reported in association with a variety of conditions. ⋯ The cause of HPVG without pneumatosis intestinalis is variable. Good knowledge of the possible causes combined with the clinical picture and the abdominal computed tomographic scan is required to correctly identify the underlying cause of HPVG and to avoid unnecessary surgery.
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Randomized Controlled Trial Clinical Trial
Reversible cardiac sympathectomy by high thoracic epidural anesthesia improves regional left ventricular function in patients undergoing coronary artery bypass grafting: a randomized trial.
To evaluate the effects of high thoracic epidural anesthesia (TEA) on global and regional myocardial function and on perioperative coronary risk in patients undergoing coronary artery bypass grafting. ⋯ Reversible cardiac sympathectomy by high TEA improves regional left ventricular function and reduces postoperative ischemia after coronary artery bypass grafting. These effects of high TEA may improve the long-term outcome after myocardial revascularization.
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Population-based hospital data indicate that African American patients undergo major lower extremity (LE) amputation 2 to 3 times more frequently than white patients. Some have attributed this to a lack of access to LE revascularization procedures by African American patients. To determine the likelihood that racial disparities in amputation rates are related to treatment choice, this study examines rates of primary amputation (major amputation without any previous attempt at revascularization) and repeat amputation. ⋯ The racial disparity at the study institution was primarily due to African American patients undergoing repeat major amputation at a significantly higher rate than whites.
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To focus the efforts of a hospital-based injury prevention outreach program, information on patient demographics, community characteristics, and catchment area must be known. ⋯ The catchment area represented by the bulk of patients admitted to a level I urban trauma center is compact and economically disadvantaged. While overall trauma mortality has decreased, GSWs are more lethal and prevalent in teenagers and young men. This identifies violence prevention as an area of emphasis.
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Operative mortality rates for esophageal resection vary across hospital volume groups in a nationally representative sample of hospitals. ⋯ The operative mortality rate for esophageal resection varies across hospitals in the United States. To improve the quality of care and reduce operative mortality rates for patients in need of esophageal surgery, patients should either be referred to higher-volume hospitals, or quality improvement should be directed at lower-volume hospitals.