Biodebridement: a case report of maggot therapy for limb salvage after fourth-degree burns.

The wound healing and antimicrobial properties of maggots are well known. Maggot debridement therapy has been used for the treatment of various conditions. For maggot debridement therapy, the larvae of the blowfly are applied over necrotic or nonhealing wounds.

Pharmacokinetics and burn eschar penetration of intravenous ciprofloxacin in patients with major thermal injuries.

Adequate penetration of antibiotics into burn tissue and maintenance of effective serum levels are essential for the treatment of patients sustaining major thermal injuries. The pharmacokinetics and burn eschar penetration of intravenous ciprofloxacin were determined in 12 critically ill patients with burn injuries. Mean age for the 12 patients was 45 +/- 17 (range 25-82 years), total body surface area burned (TBSAB) = 38 +/- 15% and Acute Physiology and Chronic Health Evaluation (APACHE) II score = 8 +/- 6.

The epidemic of cocaine-related juxtapyloric perforations: with a comment on the importance of testing for Helicobacter pylori.

Objective: This is a report of 50 consecutive patients with juxtapyloric perforations after smoking "crack" cocaine (cocaine base) at one urban public hospital.

Summary Background Data: Although the exact causal relation between smoking crack cocaine and a subsequent juxtapyloric perforation has not been defined, surgical services in urban public hospitals now treat significant numbers of male addicts with such perforations. This report describes the patient set, presentation, and surgical management and suggests a possible role for Helicobacter pylori in contributing to these perforations.

Spinal cord injuries in adolescents after gunshot wounds: an increasing phenomenon in urban North America.

While much attention is focused on firearm fatalities, the purpose of this study was to determine the expense of acute medical care and the rehabilitation experience of surviving adolescent patients in the USA with spinal cord injury secondary to gunshot wounds. We analyzed a cohort of 19 patients, 18 of whom survived 12 months after spinal cord injury. The need for primary medical care related to the injury, current work and scholastic status, and satisfaction with the quality of rehabilitation were determined.

Cost and morbidity associated with antibiotic prophylaxis in the ICU.

Background: Although the high cost and inappropriate use of antibiotics have been documented before, we are not aware of any data on nonsurgical site infectious morbidity associated with prolonged courses of prophylactic antibiotics (PA).

Study Design: Data regarding antibiotic orders were collected using a custom designed microbiology database in the Surgical Intensive Care Unit of a teaching hospital from October 1, 1995 through April 30, 1997. The database was retrospectively reviewed.

Management of casualties from the bombing at the centennial olympics.

Background: The explosion of a bomb 75 to 100 yards away from attendees at a concert who were in the process of being evacuated from Centennial Olympic Park at approximately 1:25 AM on July 27, 1996, resulted in a multiple-casualty event involving primarily four hospitals in proximity to the blast. The purpose of this study was to review triage and care of the victims, emphasizing those with significant injuries.

Methods: Retrospective review of triage and care of injured patients.

Empiric therapy of sepsis in the surgical intensive care unit with broad-spectrum antibiotics for 72 hours does not lead to the emergence of resistant bacteria.

Background: It is our practice to treat suspected sepsis with imipenem/cilastatin and gentamicin (IMP/GENT) for 72 hours while awaiting culture results. We wanted to determine if this practice engenders antimicrobial resistance.

Methods: Review of prospectively collected data regarding use of IMP/GENT and microbial sensitivity to imipenem/cilastatin during the first and last 7 months of a 19-month study period (October 1, 1995, to April 30, 1997).

Laparoscopic cholecystectomy in cirrhotic patients.

Background: Reported mortality for open cholecystectomy in patients with cirrhosis ranges from 10% to 80%. Laparoscopic cholecystectomy has gained acceptance in the general population and has become the procedure of choice for symptomatic cholelithiasis. We reviewed our experience with the use of laparoscopic cholecystectomy in this group.

Can surgeons evaluate emergency ultrasound scans for blunt abdominal trauma?

Objective: To determine whether surgeons and residents with minimal training can evaluate accurately emergency ultrasound (US) examinations compared with radiologists for blunt abdominal trauma.

Methods: Over 7 months, we conducted a prospective study comparing the evaluation of emergency US for blunt abdominal trauma by surgeons and attending radiologists. US readings from the surgical team and the radiologists were correlated with outcome.

Rapid detection of traumatic effusion using surgeon-performed ultrasonography.

Background: In the injured patient, rapid assessment of the thorax can yield critical information for patient management and triage.

Objectives: The objectives of this prospective study were (1) to determine if experienced surgeon sonographers could successfully use a focused thoracic ultrasonographic examination to detect traumatic effusion, and (2) to compare the accuracy and efficiency of ultrasonography with supine portable chest radiography.

Methods: Surgeon-sonographers performed thoracic ultrasonographic examinations on patients with blunt and penetrating torso injuries during the Advanced Trauma Life Support secondary survey.

A reappraisal of the role of Gram's stains of tracheal aspirates in guiding antibiotic selection in the surgical intensive care unit.

Background: Tracheal aspirate Gram's stains are used to guide antibiotic selection in empiric pneumonia treatment in the surgical intensive care unit (SICU). We questioned whether Gram's stains predict the organism cultured.

Methods: A retrospective review of prospectively collected data.

Trends in resident experience in open and laparoscopic cholecystectomy.

Laparoscopic cholecystectomy (LC) has replaced open cholecystectomy (OC) as the most common operation for gallbladder disease. Our goal was to determine the effect of this phenomenon on resident training in biliary surgery. The numbers of all cholecystectomies (ACs), OCs, LCs, and advanced procedures (common bile duct exploration and choledochoscopy, (CBDE) performed by residents during academic years 1989 to 1994 were examined.

Spontaneous rupture of abdominal aortic aneurysms in patients with non-related blunt traumatic injuries.

As the population ages, abdominal aneurysms are expected to increase in frequency, as well as in the number of elderly patients involved in automobile trauma. Therefore, the number of incidental abdominal aortic aneurysms found in elderly trauma patients should be expected to rise. The purpose of this paper is to report two cases of ruptured abdominal aortic aneurysms found after nonassociated blunt trauma.

Penetrating trauma secondary to heterotopic ossification in a laparatomy scar: a case report.

Heterotopic ossification is a common complication of numerous procedures, including abdominal operation, but traumatic perforation by such ossification is extremely rare. A 45-year-old man suffered traumatic perforation of the jejunum by ossification in a laparotomy scar. The diagnosis was made only at operation.

Utility of admission chemistry and coagulation profiles in trauma patients: a reappraisal of traditional practice.

To determine whether abnormal results of admission serum chemistry profiles (P7: sodium (Na), potassium (K), chloride (Cl), carbon dioxide content (CO2), blood urea nitrogen (BUN), creatinine (Cr), and glucose (GLU), amylase (AMY), and coagulation profiles (CP: prothrombin time (PT) and partial thromboplastin time (PTT) in trauma patients lead to clinical interventions, and to characterize frequency of abnormal results, we prospectively gathered laboratory data on 500 consecutive patients seen in our Level 1 trauma center. Clinicians were blinded to the study. Abnormal results were found in 93% of P7s, 7% of AMYs, and 59% of CPs.

1,000 consecutive ultrasounds for blunt abdominal trauma.

Diagnostic peritoneal lavage (DPL) and computed tomography (CT) are the primary diagnostic modalities used in the evaluation of patients with suspected blunt abdominal trauma (BAT). DPL is fast and accurate but is associated with complications. CT is also accurate, yet requires stability and transportability of the patients.

Laparoscopic colostomy for a gunshot wound to the rectum.

The role of laparoscopy in the management of trauma patients is evolving. We describe a case of a laparoscopically created colostomy for treatment of a gunshot wound to the rectum.

Laparoscopic repair of a gunshot wound to the diaphragm: a case report.

The application of laparoscopy to the surgery of trauma is rapidly expanding. We report a case of laparoscopic repair of a gunshot wound to the right diaphragm. We discuss a technique for repair, as well as a method to create and maintain pneumoperitoneum while avoiding tension pneumothorax.