Urgent management of a giant scrotal hernia.
Humans; Male; Middle Aged; Scrotum/*surgery; Abscess/etiology/therapy; Diabetes Complications; Hernia/complications; Herniorrhaphy; Postoperative Complications/therapy; Genital Diseases; Male/complications/surgery
An unusual case of giant scrotal hernia is presented. Hernias of this magnitude are extremely rare, even in underdeveloped countries, and their repair is challenging to the surgeon and stressful to the patient. Only a few case reports on the use of pneumoperitoneum prior to herniorrhaphy have been published; however, our patient's accompanying complications of diabetes mellitus and gastrointestinal symptoms precluded the use of pneumoperitoneum. The emergency management, including the expansion of the abdominal cavity with prosthesis, the ensuing postoperative complications, and the patient outcome, are discussed.
Abdu R A
The American surgeon
1990
1990-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Portal pyelophlebitis identified by CT scan in a patient with ischemic bowel.
Humans; Male; Aged; Necrosis; Fatal Outcome; *Portal System; Ischemia/*complications/pathology; Phlebitis/diagnostic imaging/*etiology; X-Ray Computed; *Tomography; Intestine; Embolism; Air/diagnostic imaging/*etiology; Small/*blood supply
A 65-year-old male was found to have hepatic portal venous gas (HPVG) by computed tomogram secondary to ischemic bowel. Despite aggressive surgical and antibiotic treatment, the patient died within 12 hours. Portal pyelophlebitis, when identified by air in the portal venous system, is a grave indicator of ischemic bowel with a very high mortality rate, except in patients with inflammatory bowel disease.
Ghani A; Kasirajan K; Smith J
The American surgeon
1995
1995-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Disseminated brown tumors from hyperparathyroidism masquerading as metastatic cancer: a complication of parathyroid carcinoma.
Female; Humans; Middle Aged; Carcinoma/*complications; Hyperparathyroidism/complications; Kidney Neoplasms/pathology; Osteitis Fibrosa Cystica/*diagnosis/*etiology; Parathyroid Neoplasms/*complications; Diagnosis; Carcinoma; Differential; Renal Cell/secondary
Osteitis fibrosa cystica (brown tumors) can be a skeletal manifestation of advanced hyperparathyroidism, including parathyroid cancer. Severe osteitis fibrosa cystica can mimic metastatic bone diseases especially in patients with a history of cancer. Because the treatment and prognosis of these two problems differ greatly considering hyperparathyroidism in the differential diagnosis of patients found to have osteolytic lesions is critical for the appropriate management of these patients. In this case report we describe a patient with a history of renal cell cancer and presumed osteolytic bone metastases. During prophylactic intramedullary rodding to prevent pathologic fracture of her femur she was found to have a benign lesion related to her previously undiagnosed hyperparathyroidism caused by an underlying parathyroid cancer. A detailed review of this disease and the associated bone changes is also included to underscore the importance of an adequate differential diagnosis as well as optimal management. Patients with hypercalcemia or bony lesions should not automatically be treated palliatively for metastatic disease just because of a past medical history of cancer. Hyperparathyroidism is a readily curable problem if properly diagnosed.
Gupta A; Horattas M C; Moattari A R; Shorten S D
The American surgeon
2001
2001-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Delayed presentation of an inflammatory polyp following colonic ischemia.
Female; Humans; Time Factors; Aged; Colitis/*etiology/pathology/surgery; Colon/*blood supply; Colonic Polyps/diagnosis/*etiology/pathology/surgery; Colonoscopy; Ischemia/*complications
Inflammatory polyps are usually associated with inflammatory bowel disease. The majority of these lesions are asymptomatic, however, they may be a source of obstruction or hemorrhage. These polyps represent re-epithelialization of the damaged colonic mucosa. Although inflammatory polyps have been associated with the acute phase of ischemic colitis, there has been only one report of delayed presentation of a symptomatic inflammatory polyp following ischemic injury to the colon. We present the second such report and a review of the literature.
Pidala M J; Slezak F A; Hlivko T J
The American surgeon
1993
1993-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Trauma attending in the resuscitation room: does it affect outcome?
Adult; Humans; Time Factors; Retrospective Studies; Workforce; Survival Rate; Quality of Health Care; *Outcome and Process Assessment (Health Care); *Resuscitation; *Trauma Centers; Personnel Staffing and Scheduling; Wounds and Injuries/mortality/therapy; Emergency Service; Hospital; Hospital/*statistics & numerical data; Medical Staff
Although there are no Class I data supporting the regionalization of trauma care the consensus is that trauma centers decrease morbidity and mortality. However, the controversy continues over whether trauma surgeons should be in-house or take call from home. The current literature does not answer the question because in all of the recent studies the attendings who took call from home were in the resuscitation room guiding the care. We believe the correct question is: Does the presence of the trauma attending in the resuscitation room make a difference? At a university-affiliated Level II trauma center data from the trauma registry, resuscitation room flowsheet, and dictated admission notes were reviewed on all patients over a 6-month period. Data points were: attending present in the resuscitation room, standard demographics, resuscitation room time, time to operating room (OR), time to CT scan, length of stay, complications, and mortality. A total of 943 patients were studied with 216 (23%) having the attending present in the resuscitation room and 727 (77%) without the attending present. The groups were similar in terms of age, sex, Injury Severity Score, percentage Injury Severity Score greater than 15 (16-17.1%), and mechanism of injury (24-29% penetrating). Of all the data points studied only time to the OR had a statistically significance difference (P \textless 0.05) with it taking 43.8 minutes (+/-20.1) when the attending was present and 109.4 minutes (+/-107) when the attending was absent. There were also no missed injuries, delays to the OR, or inappropriate workups when the attendings were present. Only the time to the OR reached statistical significance. The time to the OR is indicative of the decision-making process in the resuscitation room, and it is in this area that the attendings' presence is the most useful. Also, we believe that it is important that there were no missed injuries, delays to the OR, or inappropriate workups when the attendings were present in the resuscitation room. This again speaks to the decision-making process. We believe that these data support the need for the attending to be present in the resuscitation room to facilitate accurate and timely decisions regardless of whether they take the call from home or in-house.
Porter J M; Ursic C
The American surgeon
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Cyanide toxicity in the surgical intensive care unit: a case report.
Female; Humans; Aged; Intensive Care Units; Cyanides/*poisoning; Hypertension/complications/*drug therapy; Nitroprusside/administration & dosage/pharmacokinetics/*poisoning; Poisoning/diagnosis/therapy; Wounds and Injuries/complications/therapy
Hypertension is a widespread entity in the surgical intensive care unit. Not only is the clinical spectrum varied, but the armamentarium available to the clinician is also wide-ranging. Sodium nitroprusside, a potent vasodilator with a short half-life, is often used for hypertensive crisis and to deliberately maintain a low blood in certain clinical conditions. Cyanide toxicity is a known complication of sodium nitroprusside use. Herein is reported a case of probable cyanide toxicity in an elderly trauma patient. The pharmacology of sodium nitroprusside and the pitfalls of making the diagnosis of cyanide toxicity are discussed.
Sipe E K; Trienski T L; Porter J M
The American surgeon
2001
2001-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The effect of renal range dopamine and norepinephrine infusions on the renal vasculature.
Animals; Dogs; Cardiac Output; Norepinephrine/*pharmacology; Creatine/pharmacokinetics; Dopamine/*pharmacology; Kidney/*drug effects/metabolism; Renal Circulation/*drug effects
Renal range dopamine's value was assessed in 15 hypotensive canines using an endotoxin shock model and concurrent pharmacological pressor support. The dogs were prospectively randomized into three treatment groups (fluid resuscitation, fluid and norepinephrine, and fluid, norepinephrine and renal range dopamine). The two groups treated with norepinephrine showed no statistical difference between their pulmonary capillary wedge pressure, systolic blood pressure, and systemic vascular resistance. Cardiac index was slightly increased in the dopamine group (P less than 0.001). Creatinine clearance and renal blood flow were found to have no differences with or without renal range dopamine infusing in either group (P = 0.39 and P = 0.45, respectively). These findings suggest that renal range dopamine is not efficacious with concurrent alpha sympathetic agents for augmentation of renal function or flow in the hypotensive experimental model.
Strigle T R; Petrinec D
The American surgeon
1990
1990-08
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Rare case of Castleman disease involving the pancreas.
Adult; Female; Humans; Castleman Disease/*diagnosis/*surgery; Pancreatic Diseases/*diagnosis/*surgery
Castleman disease, also known as angiofollicular lymph node hyperplasia, is an uncommon tumor involving lymph node tissues. The most common location is in the thorax presenting as a mediastinal mass. In the abdomen, most of the lesions are located in the pelvis, mesentery, and retroperitoneum. Only nine other cases of Castleman disease involving the pancreas have been described. We report a case of Castleman disease (hyaline vascular type) presenting as a pancreatic mass and an enlarged spleen. A 23-year-old woman presented with a 2-month history of abdominal pain localized to the left upper quadrant. Ultrasound and CT demonstrated a large retrogastric pancreatic mass and an enlarged spleen. Distal pancreatectomy and splenectomy were performed. Histopathologic examination revealed a markedly enlarged lymph node showing germinal centers with hyalinization and prominent follicular dendritic cells meshwork surrounded by concentric layers of small lymphocytes. Within the interfollicular area were regions of increased vascularity. BCL2, CD20, and CD79a show expanded mantle zones with a concentric targetoid arrangement of small lymphocytes. This is a case of unicentric Castleman disease of the hyaline-vascular type, which presented with signs and symptoms of a primary pancreatic neoplasm.
Tunru-Dinh Vonny W; Ghani Abdul; Tom Yuel D
The American surgeon
2007
2007-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).