RESUMEN
Penetrating thoracoabdominal injuries caused by stabbing or firearms are seen on an almost daily basis at trauma centers in the USA. The nonoperative management of carefully selected hemodynamically stable patients is still under dispute. We present a case of right thoracoabdominal firearm injury managed nonoperatively.
RESUMEN
Motocross has become a popular recreation activity in Southern California, particularly in the Inland Empire area. In order to evaluate the patterns of injury and outcomes associated with motocross accidents, the Trauma Registry data and charts of all patients with motocross-related injuries from January 2000 to December 2001 were reviewed. Of the 270 patients studied, 265 were males and 5 were females, with a mean age of 26 years (range, 5-61). The mean Injury Severity Score was 6.8 (range, 1-38). Injuries involved extremity trauma in 52 per cent of patients closed head injuries in 33 per cent, blunt chest trauma in 23 per cent, abdominal trauma in 15 per cent, spinal trauma in 14 per cent, and pelvic trauma in 8 per cent. Surgery was required in 96 patients (36%), most commonly for treatment of orthopedic injuries. After initial evaluation, 179 patients were admitted (66%), 60 were discharged home (22%), 29 were transferred for higher level of care (11%), and two expired (1%). The mean hospital length of stay was 2.3 days (range, 1-9). Motocross accidents are most commonly associated with extremity injuries and closed head trauma. Although the overall mortality is low, the morbidity is high, with a large proportion of patients requiring surgery.
Asunto(s)
Vehículos a Motor Todoterreno , Heridas y Lesiones/etiología , Traumatismos Abdominales/epidemiología , Traumatismos Abdominales/etiología , Adulto , California/epidemiología , Extremidades/lesiones , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Traumatismos Cerrados de la Cabeza/epidemiología , Traumatismos Cerrados de la Cabeza/etiología , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Sistema de Registros/estadística & datos numéricos , Traumatismos Vertebrales/epidemiología , Traumatismos Vertebrales/etiología , Traumatismos Torácicos/epidemiología , Traumatismos Torácicos/etiología , Heridas y Lesiones/epidemiologíaRESUMEN
As long-term arteriovenous (AV) access for hemodialysis becomes more prevalent in human immunodeficiency virus (HIV)-positive patients it is important to evaluate the complications associated with each surgical technique. The records of 37 consecutive HIV-positive patients undergoing surgery for AV hemodialysis access were reviewed. Cases were analyzed for age, gender, presence of acquired immunodeficiency syndrome (AIDS), surgical procedure, and complications. AV fistulas were performed primarily in 23 patients, and prosthetic grafts were used in 14. There was no difference between these two groups in regard to age (P = 0.510), gender (P = 0.620), or presence of AIDS (P = 0.97). Complications requiring one or more reoperations occurred in four patients (17%) after AV fistulas and in seven patients (50%) after AV grafts (P = 0.035). When reoperations were accounted for a total of 28 AV fistulas and 20 AV grafts were performed with an overall complication rate of 21 and 70 per cent respectively (P = 0.001). Complications after AV grafts included thrombosis (40%), infection (25%), and aneurysm (5%). Thrombosis was the only complication observed after AV fistula (21%). The complication rate after AV access in HIV-positive patients was significantly greater after AV graft insertion than after AV fistulas, which resulted in a higher rate of reoperation. AV fistula when feasible should be considered the procedure of choice in this group of patients.