Anna M. Ledgerwood

Treatment of Liver Injuries: An Overview

The liver is the largest organ in the body and the organ most frequently injured. This is true for both blunt and penetrating wounds. The morbidity and mortality associated with liver injury vary with the associated hemorrhagic shock insult, the severity of liver injury as judged by the Abbreviated Injury Score (AIS), and the presence or absence of bleeding at the time of operative intervention. The severity of injury related to missile wounds correlates directly with the amount of energy that is dissipated as the missile traverses the liver, with the energy being calculated by the classic formula of energy = mass × volume 2 ÷ 2. Thus, high velocity missiles have the greatest potential for creating the worst injuries. When a patient with a liver injury presents with severe hemorrhagic shock that is not rapidly reversible with preoperative resuscitation, the mortality is very high; when the hemorrhagic shock insult is corrected while in transit to the operating room, the mortality is low; when there is no associated hemorrhagic shock, the mortality is negligible.

Penetrating Neck Trauma

Consequently, the challenges regarding care of penetrating neck wounds relate to injuries in the anterior triangles. These challenges include 1) emergent airway control, 2) immediate control of active bleeding, 3) urgent operative treatment of major injuries not causing acute airway compromise or life-threatening bleeding, 4) urgent diagnostic investigations for patients not requiring emergent or urgent operation, 5) deciding whether to explore or observe stable patients, 6) optimal exposure for patients requiring operation, and 7) care of specific injuries.

Cyto Reduction for Soft Tissue Sarcomas

Eradication of all malignant disease is the uniform objective of therapy. Such eradication usually is achieved by surgical excision, whereas, in some instances a tumor may be best treated by chemotherapy, radiation therapy, or some combination of all three. Surgical excision, alone, as a definitive treatment of many gastrointestinal carcinomas yields a cure when the disease is diagnosed prior to extension though the gut wall and when adequate margins beyond the gross tumor are included in the resected specimen. This type of resection allows for a three-dimensional or circumferential excision of both tumor and surrounding tumor free tissues. Surgical excision of other tumors such as the papillary adenocarcinomas of the thyroid will be associated with long-term free interval even through a wide margin of tumor free tissue is not incorporated with the resected specimen; long-term thyroid replacement therapy facilitates suppression of subsequent tumor growth. Other tumors such as embryonal cell sarcomas in males and choriocarcinoma in females may be most effectively treated with chemotherapy with surgical excision being used primarily for diagnosis, cyto reduction and stern cell analysis.