A decade's experience with temporary intravascular shunts at a civilian level I trauma center.

Background: A 10-year review of temporary intravascular shunts (TIVS) at a regional trauma center.

Methods: Retrospective chart review of all patients treated with temporary intravascular shunts from January 1, 1997 to January 1, 2007.

Results: Seven hundred eighty-six patients were treated for vascular injuries.

Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease.

Purpose: To systematically study potential adverse events associated with the use of intraocular bevacizumab at a single medical center.

Methods: Retrospective study of all consecutive patients receiving intraocular bevacizumab injections at the Stanford University Department of Ophthalmology between November 15, 2005 and July 14, 2006. Bevacizumab was given for exudative age-related macular degeneration, retinal vascular occlusion, diabetic macular edema, neovascular glaucoma, and five other indications.

Acetabular and isolated pelvic ring fractures: a comparison of initial assessment and outcome.

The purpose of this study was to describe the comparative outcomes of patients with pelvic ring fractures, acetabular fractures, and combinations of the same. Patients with pelvic or acetabular fractures were identified in the Hospital Trauma Registry, and all appropriate data were collected by reviewing the patients' medical records, the hospital operative logs, transfusion records, and the records of surgical morbidity conferences. Patient management was consistent over the time period of the study.

Computed tomographic evidence of hepatic portal venous gas after blunt abdominal trauma does not necessitate surgery.

Historically, hepatic portal venous gas (HPVG) seen on abdominal radiographic examination indicated serious intra-abdominal pathology requiring urgent operative intervention. The mortality attributed to HPVG is associated closely with its causative source rather than a direct effect of the presence of venous air and, therefore, the finding should be correlated with a careful clinical examination before any therapeutic endeavor. Fourteen cases of HPVG associated with blunt trauma have been reported over the past 20 years, and only half of these have resulted in surgery.

Pancreatic Trauma Revisited.

Pancreatic trauma is rare with an incidence between one and two percent in patients with abdominal trauma. Morbidity and mortality, however, are significant with rates approaching 40-45% in some reports. The majority of patients with injuries to the pancreas have associated trauma to other organs which are primarily responsible for the high mortality rate.

The management of pancreatic trauma in the modern era.

Pancreatic trauma presents challenging diagnostic and therapeutic dilemmas to trauma surgeons. Injuries to the pancreas have been associated with reported morbidity rates approaching 45%. If treatment is delayed, these rates may increase to 60%.

Can secondary extremity compartment syndrome be diagnosed earlier?

Background: In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70%. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome.

The accuracy of thoracic ultrasound for detection of pneumothorax is not sustained over time: a preliminary study.

Background: Ultrasound has proven to be very accurate in the diagnosis of pneumothorax in the trauma suite. It is unknown whether this accuracy is maintained over time in patients with a thoracostomy (TT) in place.

Methods: Hospitalized patients with a TT placed to treat a traumatic pneumothorax underwent serial daily bedside surgeon-performed ultrasound by 1 of 2 experienced surgeon sonographers who were unaware of concomitant X-ray findings.

What is the optimal observation time for a penetrating wound to the flank?

Options for a hemodynamically stable patient with a penetrating wound to the flank or back but no peritonitis, includes serial physical examinations versus a triple-contrast CT scan. There is, however, little consensus on the minimum time for serial examinations to exclude an injury that requires an operation. Therefore, a retrospective review of patients who sustained a penetrating wound to the flank or back and were admitted to a Level I trauma center was performed.

Torso vascular trauma at an urban level I trauma center.

Injuries to the great vessels of the torso are more commonly seen and managed in busy urban trauma centers. This same injury complex is rarely seen in military conflicts, likely due to the high kinetic energy wounding mechanisms seen in this setting. While most of the great advancements in trauma surgery over the past century have generally resulted from our wartime experience, civilian centers have contributed greatly to the understanding and management of torso vascular injuries.

The outcome of open pelvic fractures in the modern era.

Background: Recent series have reported that the mortality rate of open pelvic fractures has decreased to < 10%. These injuries are often associated with intra-abdominal visceral damage, although few series have documented the prognostic significance of this injury complex.

Methods: A retrospective review in an urban level I trauma center of all patients who sustained open pelvic fracture between 1995 and 2004.

Emergent right hemicolectomies.

Emergent right hemicolectomies have historically been associated with surprisingly high morbidity and mortality rates. A retrospective review of emergent right hemicolectomies over a 7-year period was performed to assess current morbidity and mortality. Emergent right hemicolectomy was defined as a procedure performed for an acute abdomen with no formal preoperative cleansing of the colon.

Opinions of trauma practitioners regarding prehospital interventions for critically injured patients.

Background: Significant controversy surrounds the prehospital management of trauma patients.

Methods: A questionnaire describing clinical scenarios was mailed to a random sample of 345 trauma practitioners.

Results: The 182 trauma practitioners (52.

A review of upper extremity fasciotomies in a level I trauma center.

The purpose of this study was to review recent experience with upper extremity fasciotomy. This study is a retrospective review of injured patients undergoing fasciotomy in the upper extremity at an urban trauma center. Mechanisms of injury, indications for and timing of fasciotomy, role of compartment pressures, techniques of closure, amputation rate, and patient outcomes were collected.

Rhabdomyolysis and secondary renal failure in critically ill surgical patients.

Background: 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.

Methods: A retrospective review of all surgical, trauma, burn, and pediatric surgical patients admitted to Grady Memorial Hospital in Atlanta, GA, from January 1995, through April 2002 was performed.

A survey assessment of the level of preparedness for domestic terrorism and mass casualty incidents among Eastern Association for the Surgery of Trauma members.

Objective: The goal of this survey was to establish a benchmark for trauma surgeons' level of operational understanding of the command structure for a pre-hospital incident, a mass casualty incident (MCI), and weapons of mass destruction (WMD). The survey was distributed before the World Trade Center destruction on September 11, 2001.

Methods: The survey was developed by the authors and reviewed by a statistician for clarity and performance.

Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same.

Background: Damage control surgery (DCS) and treatment of abdominal compartment syndrome have had major impacts on care of the severely injured. The objective of this study was to see whether advances in critical care, DCS, and recognition of abdominal compartment syndrome have improved survival from penetrating abdominal injury (PAI).

Methods: The care of 250 consecutive patients requiring laparotomy for PAI (1997-2000) was reviewed retrospectively.

Management and short-term patency of lower extremity venous injuries with various repairs.

Background: Although several methods of repair of extremity venous injuries have been shown to be efficacious, patency rates have varied significantly from center to center.

Methods: A retrospective review was made of treatment outcomes of adult and pediatric patients with major venous injuries of the lower extremity.

Results: From 1997 to 2002, 82 patients sustained 86 major lower extremity venous injuries.

Are resuscitation and operation justified in injured patients with extreme base deficits (less than -20)?

Background: This study assessed the outcome of injured patients in shock with an admission base deficit of -20 or less (approximate pH <7.0) at a level 1 trauma center.

Methods: A retrospective review was made of the trauma registry, supplemented by chart review, of all trauma patients admitted with a base deficit -20 or less from 1995 to 2002.

A two institution experience with 226 endoscopically placed jejunal feeding tubes in critically ill surgical patients.

Background: Early jejunal feeding after surgery or trauma reduces infectious complications. Although not ideal gastric and postpyloric feedings are often used, however, because of difficulty in placing feeding tubes distal to the ligament of Treitz (LOT). Our hypothesis was that feeding tube placement distal to the LOT can be accomplished using a bedside transendoscopic technique.