RESUMO
A retrospective review was performed of 98 patients admitted to a Level I Trauma Center between July 1989 and December 1990 with a diagnosis of blunt chest trauma. Of these patients, 49% suffered either immediate or delayed complications. Immediate complications included hemothorax or pleural effusion in 21.4%, pneumothorax in 36.7%, and ruptured diaphragm in 2%. Delayed complications occurred in 29.6% of patients overall; these included pulmonary contusion in 33.7%, pneumonia in 5.1%, and pulmonary embolus in 1.0%. Both initial Trauma Score (TS) and the Injury Severity Score (ISS) were predictive of mortality. The mortality rate was significantly greater in patients with a TS < or = 13-30.2% of these patients died of their injuries as opposed to 1.9% of those with a TS > 13. Similarly, 19.7% of patients with an ISS > or = 16 died, while all patients with an ISS < 16 survived. These differences were statistically significant (p < 0.001 and p < 0.05, respectively). Neither TS nor ISS, however, was predictive of either immediate or delayed complications. Even with a TS > 13, 47.2% of patients suffered complications; 80% of these patients had delayed complications. Similarly, 51.8% of patients with ISS < 16 had complications. Statistically, neither TS nor ISS could be used to predict complications, regardless of the reference value chosen for TS or ISS. Therefore, it is imperative that all patients with blunt trauma be considered at risk for secondary complications, even those with "favorable" TS or ISS.
Assuntos
Pneumopatias/epidemiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Traumatismos Torácicos/mortalidade , Fatores de Tempo , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/mortalidadeRESUMO
One hundred cases of patients who underwent urgent cholecystectomy after presenting with symptoms of acute or subacute gallbladder disease were retrospectively reviewed. Sixty patients had pathologically proved acute cholecystitis, and 40 had chronic cholecystitis alone. One patient had an incidental gallbladder carcinoma, and four had global gangrene of the gallbladder. Focal ischemia, transmural hemorrhage, or focal necrosis (indicating more severe disease) was present in 19 patients. Fifty-four percent of patients had thin-walled gallbladders. Among patients with more severe acute disease, 56% had thin walls. Conversely, 24% of thin-walled gallbladders and 22% of thick-walled gallbladders had evidence of focal necrosis or gangrene. We conclude that gallbladder wall thickness, although demonstrable on preoperative ultrasound examination in all patients, does not correlate directly with severity of disease or pathologic findings.
Assuntos
Doenças da Vesícula Biliar/patologia , Vesícula Biliar/patologia , Doença Aguda , Colecistite/patologia , Colelitíase/patologia , Doença Crônica , Técnicas de Diagnóstico por Cirurgia , Feminino , Vesícula Biliar/irrigação sanguínea , Gangrena/patologia , Hemorragia/patologia , Humanos , Isquemia/patologia , Masculino , Necrose , Estudos RetrospectivosRESUMO
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.