Diagnostic peritoneal lavage: is 100,000 RBCs a valid figure for penetrating abdominal trauma?

Background: Controversy exists regarding the interpretation of diagnostic peritoneal lavage results. This is especially true in the evaluation of patients sustaining penetrating trauma, specifically stab wounds to the lower chest and abdomen. Ideally one wants to avoid missed injuries and minimize unnecessary operations.

Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill.

Background: Resident work hours may impact patient care. We hypothesized that "call-associated" acute sleep deprivation has no effect on technical dexterity as measured on a minimally invasive surgery trainer, virtual reality (MIST VR) surgical simulator.

Methods: Thirty-five surgical residents were prospectively evaluated pre-call (rested), on-call (rested), and post-call (acutely sleep deprived).

Opinions of practicing general surgeons on surgical education.

Background: Collective opinions of practicing general surgeons on the current state of general surgical resident education are unknown.

Methods: A 26-item survey was mailed to practicing general surgeons in Minnesota and Texas. Average scores on 17 Likert-formatted questions and opinions on multiple-choice questions were compared by geographic area and academic affiliation.

The Role of Laparoscopy in the Evaluation of Abdominal Trauma.

The evaluation of patients sustaining abdominal trauma remains one of the most challenging tasks for the general surgeon. Diagnostic peritoneal lavage and computerized tomography are well-established studies, each with its own indications, advantages, and disadvantages. Ultrasonography has been widely used in Europe and has only recently gained popularity in the United States.

Complex problems in penetrating neck trauma.

This article discusses the problems and controversies in the assessment of penetrating injuries of the neck. The role of physical examination and color-flow Doppler imaging in the initial assessment is highlighted. Complex injuries of major vessels, the aerodigestive tract, and the parotid are discussed and therapeutic options are presented.

Analysis of American College of Surgeons trauma consultation program.

Objective: To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification.

Methods: Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification.

American College of Surgeons Verification/Consultation Program: analysis of unsuccessful verification reviews.

Unlabelled: This study was designed to document the reasons hospitals have been unsuccessfully peer reviewed as potential trauma centers.

Method: 120 trauma center reviews were performed by a peer review program between September 1987 and December 1992 using the American College of Surgeons (ACS) criteria. Fifty-four hospitals had criteria deficiencies.

Role of laparoscopy in the evaluation of abdominal trauma.

This prospective study was designed to determine if laparoscopy is a safe and accurate method for abdominal evaluation in the trauma patient. Thirty-two patients who presented with blunt or penetrating trauma and who were scheduled for celiotomy based on clinical evaluation constituted the study group. The patients underwent diagnostic laparoscopy prior to exploratory celiotomy.

Abdominal surgical wound infection is lowered with improved perioperative enterococcus and bacteroides therapy.

Perioperative antibiotics decrease surgical wound infection (SWI) in trauma patients requiring abdominal exploration. This investigation evaluated 24 hours of cefoxitin or ampicillin/sulbactam used for early therapy in such patients. Patients were randomly assigned to one of two treatment groups.

Computed tomography in the evaluation of children with blunt abdominal trauma.

Objective: This study determined the sensitivity, specificity, and accuracy of CT in pediatric patients with blunt trauma. Correlation of the CT-identified injuries and intraoperative findings with comparison to the results of DPL was performed.

Summary Background Data: Clinical evaluation frequently is unreliable in determining the presence of intra-abdominal injury in children with blunt trauma.

Vascular proximity: is it a valid indication for arteriography in asymptomatic patients?

The role of arteriography in asymptomatic patients with penetrating extremity wounds in proximity to major vessels is controversial. This prospective study was designed to evaluate a precise definition of proximity, determine the incidence of positive arteriograms, and correlate angiographic interpretation with operative findings. Proximity was defined as any wound located within 1 cm of a major vessel.

Inner-city trauma centers. Financial burdens or community saviors?

Trauma systems have proved effective in reducing morbidity and mortality rates. Depending on a center's geographic location and patient mix between penetrating and blunt trauma, participation in a system may be a liability or an asset. In general, inner-city hospitals tend to see more indigent patients and to have sizeable financial losses.

Management of colon injuries.

The evaluation and management of colon injuries have recently undergone significant changes. The time-honored philosophy of conservative management by repair and diversion is giving way to a more aggressive approach, which includes primary repair of many injuries. The role of colostomy has been challenged by the need for additional operative procedures, patient disability, and rising hospital and medical costs.

Results of venous interposition grafts in arterial injuries.

Controversy continues regarding the use of PTFE versus autogenous vein grafts in the repair of arterial injuries. This study was designed to evaluate the results of a large series of autogenous interposition vein grafts used for arterial trauma. The charts of 191 patients with 192 arterial injuries repaired with an autogenous vein graft were reviewed.

The role of abdominal CT in the evaluation of stab wounds to the back.

Two hundred five patients with stab wounds to the back were evaluated with CT scans using both oral and IV contrast material. One hundred sixty-nine patients had a negative scan. Thirty (17.

Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma.

Three hundred one hemodynamically stable patients with equivocal abdominal examinations following blunt abdominal trauma had a CT scan followed by DPL. Both studies were negative in 194 patients (71.6%) and positive in 51 patients (27.

Intra-arterial digital subtraction angiography in the evaluation of peripheral vascular trauma.

The role of intra-arterial digital subtraction angiography (IADSA) in the evaluation of extremity trauma has not been clearly established. Several potential advantages would make IADSA a preferable study to conventional angiography (CA). This retrospective study analyzed 104 major peripheral arteries with suspected injury.

Wounds of the extremities in proximity to major arteries: value of angiography in the detection of arterial injury.

The place of angiography in the diagnosis of arterial injuries in cases of penetrating wounds of the extremities has been a source of controversy, especially when the injury is in proximity to the artery but there is no clinical evidence of arterial injury. The positive yield of angiography has been reported to be between 6% and 20%, but most angiographers suspect the yield to be lower. The cost of angiography continues to increase.

Perforated gastric ulcers. A plea for management by simple closures.

One hundred seven patients with perforated gastric ulcers were treated by either simple closures (omental patches, 81 patients; primary suture without patches, 13 patients; or ulcer excisions with closures, two patients) or primary gastric resections (11 patients). The latter were performed when ulcers were too large to be treated by simple closures. The mortality rate after omental patches or ulcer excisions with closures was 12%, while that following primary gastric resections was 45%.