Morris D. Kerstein

PENETRATING CARDIAC INJURIES

Penetrating cardiac injuries pose a tremendous challenge to any trauma surgeon. Time, sound judgment, aggressive intervention, and surgical technique are the most important factors contributing to positive outcomes. This article extensively reviews the history, surgical management, and techniques needed to deal with these critical injuries. This year commemorates the one hundredth anniversary of the first successful repair of a cardiac injury.

Prospective, Multicenter Study of Managing Lower Extremity Venous Ulcers

Seventy patients with 90 venous ulcers were randomly assigned to hydrocolloid or conventional dressing and compression therapy at four study centers. The ulcers had been present for a mean of 47.8 in the control and 46.2 weeks in the treatment group and 42% of all patients had recurrent ulcers. Ulcers treated with hydrocolloid dressings reduced 71% and control treated wounds reduced 43% in area after 7.2 weeks of treatment. Thirty-four percent of all ulcers healed. Mean time to healing was 7 weeks for the hydrocolloid dressing group and 8 weeks for the control group. Most ulcers were less painful at final evaluation, but reduction in pain was more pronounced in hydrocolloid-dressed ulcers (p=0.03). At baseline as well as during follow-up, significant differences between study centers were observed. Ulcers in patients in the United Kingdom were larger and less likely to heal (p=0.001). Size of the ulcer at baseline was associated with treatment response and time to healing (p=0.002). Percent reduction in ulcer area after 2 weeks was also correlated with treatment outcome (p=0.004) and time to healing (p=0.002). When all treatment outcome predictors were analyzed together, only percent reduction in area after 2 weeks remained statistically significant (p=0.002), with percent reduction during the first 2 weeks of treatment >30% predicting healing.

Toe amputation in the diabetic patient.

BACKGROUND We considered whether it is more practical to amputate the toe of a diabetic patient with osteomyelitis and good circulation or to treat the patient with antibiotics for a prolonged period. METHODS We undertook a retrospective study of 141 diabetic patients who had undergone a toe-ray amputation for proven or documented osteomyelitis. RESULTS The mean ankle/brachial index of all patients was 0.81 (range, 0.68 to 1.14); the mean functional days lost on antibiotic therapy was 39 (range, 7 to 84 days). The cost of 6 to 8 weeks of preoperative antibiotic therapy was

Colonoscopically guided tube decompression in Ogilvie's syndrome

900 to

Injury of a Medial Sacral Vessel During Lumbar Laminectomy

2240 (mean,

Adenocarcinoma of the ileum in a patient with cystic fibrosis

1440). CONCLUSIONS Diabetic patients with good circulation and osteomyelitis of the toe may benefit from prompt toe amputation.

Cancer knowledge and misconceptions among college undergraduates: A pilot study

Ogilvies syndrome (pseudo-obstruction of the colon) may result in gangrene and perforation of the colon if not effectively treated. Colonoscopic decompression and endoscopically guided rectal tube placement were employed to treat five patients with this syndrome who had failed medical therapy. All patients tolerated the procedure well and required no further treatment.

Study of multiple rotor-wing flight programs on emergency medical services

Vascular injury sustained during neurosurgical procedures is surprisingly rare, especially considering the anatomic proximity of major blood vessels to the vertebral column. Mortality rates are high if the injury is not recognized and definitive management is delayed. Case reports include massive hemorrhage, arteriovenous fistulas, and development of false aneurysms. Diagnostic CT scan and arteriography are useful if the patients condition permits; however, rapid intervention is crucial to the patients survival. After reviewing the current surgical literature, we present a case of medial sacral artery injury occurring during laminectomy.

Nd:Yag laser-assisted balloon angioplasty of superficial femoral artery occlusions in a diabetic population

A 30-year-old Caucasian man was admitted to the university hospital with symptoms of nausea, vomiting, colicky abdominal pain, and obstipation. His medical history was significant for CF, diagnosed as an infant. No significant surgical history existed. Six months before admission, the patient developed similar symptoms following bronchial artery embolization for the treatment of hemoptysis. He was managed conservatively for several weeks with intestinal tube decompression, mechanical cleansing with enemas, solutions to dissolve and loosen inspissated material, and hyperalimentation. This regimen served to relieve the symptoms temporarily, after which he was discharged and later readmitted in a similar state. Contrast studies of the upper and lower gastrointestinal tracts failed to disclose a definite mechanical site of obstruction. Despite several trials of conservative management, the patients symptoms would reoccur when challenged with an enterat diet. For this reason, a surgical consuItation was obtained. Physical examination disclosed a 30-year-old man with complaints of crampy abdominal pain. Vital signs were normal. Abdominal examination disclosed a mildly distended abdomen with hyperactive bowel sounds. No peritoneal signs were noted; no masses were felt. Laboratory data included a white blood cell count of 8.5 with a normal differential, and a hematocrit/ hemoglobin of 8.4/29. Obstruction series showed dilated loops of small bowel and air fluid levels. At laparotomy, a segmental obstruction was observed in the ileum. A firm lesion was present in this region. The remainder of the gastrointestinal tract appeared normal. A segmental resection of the ileum with its adjacent

Management of duodenal injuries.

A study of cancer knowledge and misconceptions among college undergraduates was undertaken with the goal of obtaining information that could be used to direct the establishment of future, problem-oriented cancer education programs. General knowledge about cancer, as well as specific knowledge about colon cancer, was found to be lacking. The former was significantly related to gender, while the latter was influenced by a family history of cancer. Knowledge about breast cancer was more complete, although, again, gender significantly impacted upon accuracy. Breast self-examination and surgical options for treating breast cancer were specific areas in which knowledge was poor.