New Trends at 25 Years: An American Board of Surgery Academic Certifying Examination Review Course.

Background: In the 1980s, a small research group began identifying variables affecting applicant success on the American Board of Surgery (ABS) Certifying Examination (CE). We now report success and trends as we complete 25 years. We had multiple challenges as identified through faculty focus groups and participant feedback that needed to be addressed: increase the national optics of the program, integrate new innovative experiences, maintain the integrity of the collected data on excel files, incorporate national trends in surgery, attract experienced clinical volunteer faculty and staff, security of capital, and schedule management.

Low-dose Prothrombin Complex Concentrate for Warfarin-Associated Intracranial Hemorrhage with INR Less Than 2.0.

Background: Prothrombin complex concentrates (PCCs) have become the first-line therapy for warfarin reversal in the setting of central nervous system (CNS) hemorrhage. Randomized, controlled studies comparing agents for warfarin reversal excluded patients with international normalized ratio (INR) <2, yet INR values of 1.6-1.

Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitors and/or histamine II receptor blockers.

Background: Ventilator-associated pneumonia (VAP) is a common cause of infectious morbidity and mortality in the intensive care unit (ICU). The type of stress-ulcer prophylaxis (SUP) given to ventilated patients may, in part, be responsible. We observed an increase in VAP as ventilator bundle compliance increased and a decrease in VAP when bundle compliance decreased.

Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis.

Objective: To examine the clinical and neurological outcome of patients who sustained a severe non-penetrating traumatic brain injury (TBI) and underwent unilateral decompressive craniectomy (DC) for refractory intracranial hypertension.

Design: Single center, retrospective, observational.

Setting: Level I Trauma Center in Portland, Maine.

Time lapse and comorbidities influence patient knowledge and pursuit of medical care after traumatic splenectomy.

Background: There is insufficient knowledge of infectious risk in patients after splenectomy; minimal data exists specifically for trauma patients. This study evaluated patient knowledge and practices regarding infection risk after traumatic splenectomy. Our hypothesis was that patients with poor knowledge regarding their asplenic state would be less likely to pursue medical care in the event of an illness than those with good knowledge.

Stability of cervical spine fractures after gunshot wounds to the head and neck.

Study Design: Retrospective chart review.

Objectives: To determine the frequency of stable and unstable cervical spine fractures after gunshot wounds to the head or neck; to identify potential risk factor(s) for an unstable versus stable cervical spine fracture.

Summary Of Background Data: Cervical spine fractures after gunshot wounds to the head and neck are common.

Evolution in the management of the complex liver injury at a Level I trauma center.

Background: Management of the severe liver injury evolved from mandatory surgical repair to a more selective approach. This paper reviews the changes in management of the severe liver injury at a Level I trauma center.

Methods: We reviewed the records of patients with severe liver injury admitted to a Level I trauma center between January 1984 and December 1995.

The efficacy of sequential compression devices in multiple trauma patients with severe head injury.

Thirty-two multiple trauma patients with severe head injury and a Glasgow Coma Scale (GCS) score of 8 or less were prospectively studied to assess the occurrence of deep venous thrombosis (DVT) and pulmonary embolism (PE). All patients required mechanical ventilation. A sequential compression device (SCD) was used in 14 patients and 18 patients received no prophylaxis for thromboembolism.

Survival determinants in patients undergoing emergency room thoracotomy for penetrating chest injury.

Survival determinants were examined in patients undergoing ERT-PCI who were admitted to the Surgical Intensive Care Unit (SICU) between January 1, 1982 and August 1, 1991. Twenty-one of 290 patients undergoing ERT-PCI (aged 14-36 years) were admitted to the SICU. Of the 21, nine survived to discharge with normal neurologic function.

The clinical significance of myocardial contusion.

In an attempt to identify a group of blunt trauma victims with asymptomatic myocardial contusion (MC) who do not benefit from intensive cardiac monitoring, we prospectively divided 336 patients admitted to the SICU with possible MC following blunt trauma in the 6 years prior to January 1990 into three groups: Group 1 (n = 155, age 30.5 +/- 9 years) consisted of those patients admitted for mechanism of injury, J-point elevation, with or without minor chest injury. None developed arrhythmias.

Traumatic hemoperitoneum due to a Meckel's mesodiverticular band: case report.

The blood supply to a Meckel's diverticulum exists either within the small bowel mesentery, or within a separate mesodiverticular band. The latter is associated with bowel obstruction. It is a rare source of hemorrhage.

Right ventricular tardokinesis in cardiac contusion: a new observation on phase images.

The usefulness of gated blood pool (GBP) scintigraphy in evaluating cardiac contusion among trauma patients was examined. In ten of 62 patients who sustained blunt chest trauma, phase images of GBP studies demonstrated delayed onset of right ventricular (RV) contractions (RV tardokinesis). Clinical charts of these ten patients were reviewed to determine the significance of this finding.

Clinical characteristics of nosocomial sinusitis.

Paranasal sinusitis is an important source of sepsis and morbidity in head injury victims and requires aggressive pursuit and therapy. Of 208 head-injured patients, 24 developed paranasal sinusitis. The Glasgow Coma Scale score of the sinusitis patients was 7.

Transvaginal injury of the duodenum, diaphragm, and lung.

An unusual case of transvaginal impalement is presented. At initial exploration the broad ligament and vagina were repaired. When bile drained from suction catheters reexploration revealed an injury to the duodenum and diaphragm.

Acute paranasal sinusitis related to nasotracheal intubation of head-injured patients.

One hundred eleven head-injured patients were examined for paranasal sinusitis during early convalescence. Glascow coma scale (GCS) was less than 8 in 79 patients. Ninety-three patients had sustained blunt injuries, and 18 had penetrating ones.

Prognosis and survival as determined by visceral amino acid clearance in severe trauma.

Sepsis, the commonest cause of late death following severe trauma, is related in part to inadequate uptake of amino acids (AA) and synthesis by the liver and other central tissues of proteins essential to immunological defense. Since 'central plasma clearance rate' of amino acids (CPCR-AA) has been found to reflect these functions, serial measurements of CPCR-AA were made in 32 seriously injured patients of whom ten died (31%), nine of sepsis. The mean Index Severity Score on admission for survivors was 31 +/- 1.

Naloxone versus placebo in treatment of septic shock.

Treatment of septic shock with naloxone was evaluated in a prospective, randomised, double-blind, placebo-controlled study in which ten episodes of shock were treated with naloxone (0.4 to 1.2 mg intravenously) and 13 with the vehicle for injection.

The clinical consequences of an industrial aerosol plant explosion.

The factors relating to the clinical outcome of an industrial aerosol plant explosion are reviewed. Eighteen of 24 workers inside the plant required hospitalization and five died. Proximity to the blast was associated with extensive injuries unless workers were shielded by physical barriers or partitions.

Changes in mitogen responsiveness lymphocyte subsets after traumatic injury: relation to development of sepsis.

Head injury and multiple trauma patients were evaluated for mitogen responsiveness and lymphocyte subset frequencies within the first few days after injury. The profile obtained was compared to the patient's clinical course to see if there was a relation between early immune abnormalities and the subsequent development of unanticipated sepsis. Lymphocytes from multiple trauma patients were generally hyporesponsive to in vitro stimulation with a suboptimal dose of the mitogen phytohemagglutinin (PHA).

Prostaglandin mediation of unstable hemodynamics during lung perfusion.

Positive end-expiratory pressure (PEEP) leads to a fall in both mean arterial blood pressure (MAP) and cardiac output (CO). This study tests the hypothesis that humoral factors, particularly prostanoids, are important mediators of these events. A support dog was used for ex vivo perfusion of an isolated left lung lobe (LLL) at a fixed flow.

Cardiopulmonary function following transfusion of three red blood cell products in elective abdominal aortic aneurysmectomy.

In order to evaluate the importance of red cell O(2) affinity of transfused blood on cardiac performance and adverse effects of transfusion on lung function, a prospective double-blind protocol was used in 27 patients undergoing abdominal aortic aneurysmectomy. Three types of blood were administered: packed red cells (PC), washed red cells (WC) and high 2,3 DPG red cells (2,3 DPG). An average of 4.

Independence of renin production and hypertension in abdominal aortic aneurysmectomy.

Seventeen patients undergoing elective repair of abdominal aortic aneurysm were examined to determine the causal mechanism for postoperative hypertension. In nine patients who had elevated systemic pressure after surgery, there were no correlations between mean arterial pressure and values of peripheral renin activity or angiotensin II. Further, no relation was demonstrated between systemic pressure and the volumes of crystalloid, colloid infused or milliequivalents of sodium administered pre- and intraoperatively.