Evaluation of splenic injury by computed tomography and its impact on treatment.

Abstract:

:We reviewed 37 consecutive, hemodynamically stable patients (16 adults, 21 children) who had splenic injuries diagnosed by computed tomography (CT) scan to compare the CT evaluation with operative assessment of injury and eventual treatment. Computed tomographic scans and operative findings were graded by a splenic injury scoring system. Two patients were classified as having grade 1, 21 as grade 2, 11 as grade 3, and 3 as grade 4 splenic injuries. Computed tomography underestimated the degree of injury in 9 of 17 (53%) operated patients (mean CT score, 2.6; mean operative score, 3.3; p less than 0.01). Six of sixteen adults and 19 of 21 children were intentionally treated by observation. There were 5 treatments failures (20%), 3 due to bleeding and 1 each due to pancreatic injury and splenic abscess. The failure rate of observation was lower in children (16%) than in adults (33%), even though children had a higher Splenic Injury Score (2.4 versus 1.8). Patients who underwent an operation received twice as much blood as the observed group. There was no significant difference in Injury Severity Score or total fluid requirements between operated and observed patients. Operations increased in frequency in both adults and children as the injury score increased. This experience suggests that CT scan accurately determines the presence of splenic injury but commonly underestimates its severity. While children with grades 1 through 3 injuries are likely to be treated successfully with observation, adults who have more minor splenic injuries often fail observation and may be treated better by prompt operation.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Malangoni MA,Cué JI,Fallat ME,Willing SJ,Richardson JD

doi

10.1097/00000658-199005000-00009

subject

Has Abstract

pub_date

1990-05-01 00:00:00

pages

592-7; discussion 597-9

issue

5

eissn

0003-4932

issn

1528-1140

journal_volume

211

pub_type

杂志文章
  • The value of thymectomy in myasthenia gravis: a computer-assisted matched study.

    abstract::In the absence of a prospective randomized study of patients treated conservatively or with thymectomy, a computer-assisted retrospective matches study was devised. Of 563 patients treated for myasthenia gravis without thymoma up to 1965, 104 had thymectomy. With computer assistance, each surgical patient was matched ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197610000-00008

    authors: Buckingham JM,Howard FM Jr,Bernatz PE,Payne WS,Harrison EG Jr,O'Brien PC,Weiland LH

    更新日期:1976-10-01 00:00:00

  • Immune RNA therapy for renal cell carcinoma: survival and immunologic monitoring.

    abstract::Twenty patients with metastatic renal cell carcinoma and nine patients with minimal residual disease (MRD) but at high risk for recurrence following nephrectomy received weekly four milligram intradermal injections of purified RNA extracted from lymphoid organs of sheep immunized with human renal cell carcinoma. Eight...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197710000-00007

    authors: Ramming KP,deKernion JB

    更新日期:1977-10-01 00:00:00

  • Cytokines, the acute-phase response, and resting energy expenditure in cachectic patients with pancreatic cancer.

    abstract:OBJECTIVE:To determine whether resting energy expenditure (REE) is increased in cachectic patients with pancreatic cancer and to define the relation of tumor necrosis factor (TNF) and interleukin-6 (IL-6) production to the acute-phase response and to REE. METHODS:Measurement of REE (indirect calorimetry) and assessmen...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199404000-00001

    authors: Falconer JS,Fearon KC,Plester CE,Ross JA,Carter DC

    更新日期:1994-04-01 00:00:00

  • Management of secondary peritonitis.

    abstract:OBJECTIVE:The authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. SUMMARY BACKGROUND DATA:Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third ...

    journal_title:Annals of surgery

    pub_type: 杂志文章,评审

    doi:10.1097/00000658-199607000-00003

    authors: Wittmann DH,Schein M,Condon RE

    更新日期:1996-07-01 00:00:00

  • Long-term Results of a Randomized Double-blinded Prospective Trial of a Lightweight (Ultrapro) Versus a Heavyweight Mesh (Prolene) in Laparoscopic Total Extraperitoneal Inguinal Hernia Repair (TULP-trial).

    abstract:OBJECTIVE:The aim of the randomized clinical trial was to compare the 2 years of clinical outcomes of a lightweight (Ultrapro) vs a heavyweight (Prolene) mesh for laparoscopic total extraperitoneal (TEP) inguinal hernia repair. BACKGROUND:Lightweight meshes reduce postoperative pain and stiffness in open anterior ingu...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000001579

    authors: Burgmans JP,Voorbrood CE,Simmermacher RK,Schouten N,Smakman N,Clevers G,Davids PH,Verleisdonk EM,Hamaker ME,Lange JF,van Dalen T

    更新日期:2016-05-01 00:00:00

  • Surgery for post-myocardial infarct ventricular septal defect.

    abstract::Forty-three patients (mean age 62 +/- 1 years) were treated for ventricular septal defect (VSD) secondary to myocardial infarction. Whenever possible, operation was postponed until six weeks post-onset chest pain. However, hemodynamic instability, evidenced by cardiogenic shock, refractory pulmonary edema, or a rising...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197709000-00004

    authors: Daggett WM,Guyton RA,Mundth ED,Buckley MJ,McEnany MT,Gold HK,Leinbach RC,Austen WG

    更新日期:1977-09-01 00:00:00

  • Effect of Esophageal Cancer Surgeon Volume on Management and Mortality From Emergency Upper Gastrointestinal Conditions: Population-based Cohort Study.

    abstract:OBJECTIVE:To study the influence of esophageal cancer surgeon volume upon mortality from upper gastrointestinal emergencies. BACKGROUND:Volume-outcome relationships led to the centralization of esophageal cancer surgery. METHODS:Hospital Episode Statistics data were used to identify patients admitted to hospitals wit...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002387

    authors: Markar SR,Mackenzie H,Askari A,Faiz O,Hanna GB

    更新日期:2017-11-01 00:00:00

  • Route and type of nutrition influence mucosal immunity to bacterial pneumonia.

    abstract:OBJECTIVE:To develop a model of established respiratory immunity against Pseudomonas aeruginosa pneumonia and to investigate the effects of route and type of nutrition on this immunity. SUMMARY BACKGROUND DATA:Diet influences the ability of gut-associated lymphoid tissue (GALT) to maintain mucosal immunity. Complex en...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199902000-00016

    authors: King BK,Kudsk KA,Li J,Wu Y,Renegar KB

    更新日期:1999-02-01 00:00:00

  • Influence of the postoperative state on the intracellular free amino acids in human muscle tissue.

    abstract::Five patients were studied before and two to three days after major, uncomplicated abdominal operation. Muscle tissue was obtained by needle biopsy from m. quadriceps femoris after eight hours overnight fast. Plasma free amino acids were analyzed in simultaneously obtained samples. In the homogenized muscle samples th...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197512000-00001

    authors: Vinnars E,Bergstöm J,Fürst P

    更新日期:1975-12-01 00:00:00

  • Higher Recurrence Rate After Endoscopic Totally Extraperitoneal (TEP) Inguinal Hernia Repair With Ultrapro Lightweight Mesh: 5-Year Results of a Randomized Controlled Trial (TULP-trial).

    abstract:OBJECTIVE:The aim of this study was to determine inguinal hernia recurrence rates 5 years after endoscopic totally extraperitoneal (TEP) inguinal hernia repair when either lightweight or heavyweight mesh was used. BACKGROUND:Recurrence is an important complication of inguinal hernia surgery. Higher recurrence rates of...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000002649

    authors: Roos MM,Bakker WJ,Schouten N,Voorbrood CEH,Clevers GJ,Verleisdonk EJ,Davids PH,Burgmans JP

    更新日期:2018-08-01 00:00:00

  • Splenic injury during resection for esophageal cancer: risk factors and consequences.

    abstract:OBJECTIVE:Esophageal cancer surgery carries a risk of splenic injury, which may require splenectomy, but predictors of such events remain uncertain. Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention. DESIGN:A population-based, nationwide cohort study was conducted on 167...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000000650

    authors: Derogar M,Sadr-Azodi O,Lagergren P,Lagergren J

    更新日期:2015-01-01 00:00:00

  • Normoxic wound fluid contains high levels of vascular endothelial growth factor.

    abstract:OBJECTIVE:To examine the temporal integration of vascular endothelial growth factor (VEGF), which has been shown to be present in wound fluid, with the putatively related processes of wound fluid oxygen content, wound angiogenesis, and granulation tissue formation. SUMMARY BACKGROUND DATA:During cutaneous wound repair...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199811000-00011

    authors: Howdieshell TR,Riegner C,Gupta V,Callaway D,Grembowicz K,Sathyanarayana,McNeil PL

    更新日期:1998-11-01 00:00:00

  • Pancreas transplantation. An initial experience with systemic and portal drainage of pancreatic allografts.

    abstract::Pancreas transplantation has evolved dramatically since its introduction in 1966. As new centers for transplantation have developed, the evaluation of complications associated with pancreas transplantation has led to advances in surgical technique. Furthermore, surgical alterations of the pancreas resulting from trans...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199206000-00005

    authors: Rosenlof LK,Earnhardt RC,Pruett TL,Stevenson WC,Douglas MT,Cornett GC,Hanks JB

    更新日期:1992-06-01 00:00:00

  • Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old.

    abstract:OBJECTIVE:By comparing cohorts in 2 exclusive time frames, the factors that affected the surgical outcomes of patients with hepatocellular carcinoma (HCC) are presented. SUMMARY BACKGROUND DATA:Reportedly, survival results of patients with HCC who underwent hepatectomy have improved in recent years. However, the major...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/01.sla.0000217921.28563.55

    authors: Taura K,Ikai I,Hatano E,Fujii H,Uyama N,Shimahara Y

    更新日期:2006-08-01 00:00:00

  • Tacrolimus and Single Intraoperative High-dose of Anti-T-lymphocyte Globulins Versus Tacrolimus Monotherapy in Adult Liver Transplantation: One-year Results of an Investigator-driven Randomized Controlled Trial.

    abstract:OBJECTIVE:The aim of the study is to evaluate whether intra-operative induction with anti-lymphocytic serum (ALS) is superior to no induction in adult liver transplantation (LT). BACKGROUND:The efficacy of ALS induction remains inconclusive in LT, because of poorly designed trials. METHODS:A randomized controlled tri...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000002943

    authors: Iesari S,Ackenine K,Foguenne M,De Reyck C,Komuta M,Bonaccorsi Riani E,Ciccarelli O,Coubeau L,Lai Q,Gianello P,Lerut J

    更新日期:2018-11-01 00:00:00

  • Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study.

    abstract:OBJECTIVE:To compare the accuracy of the modified Fried Index (mFI) and the Clinical Frailty Scale (CFS) to predict death or patient-reported new disability 90 days after major elective surgery. BACKGROUND:The association of frailty with patient-reported outcomes, and comparisons between preoperative frailty instrumen...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000002967

    authors: McIsaac DI,Taljaard M,Bryson GL,Beaulé PE,Gagné S,Hamilton G,Hladkowicz E,Huang A,Joanisse JA,Lavallée LT,MacDonald D,Moloo H,Thavorn K,van Walraven C,Yang H,Forster AJ

    更新日期:2020-02-01 00:00:00

  • The American Medical Association's Section on Surgery: The Beginnings of the Organization, Professionalization, and Specialization of Surgery in the United States.

    abstract:OBJECTIVE:To explore the founding of the American Medical Association's Section on Surgery in 1859 and how it represented, on a national basis, the beginnings of organized surgery and the formal start of the professionalization and specialization of surgery in the United States. BACKGROUND:The broad social process of ...

    journal_title:Annals of surgery

    pub_type: 传,历史文章,杂志文章

    doi:10.1097/SLA.0000000000001635

    authors: Rutkow I

    更新日期:2017-01-01 00:00:00

  • FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation.

    abstract:OBJECTIVE:The objective of this study was to examine the ability of Focused Assessment Using Sonography for Trauma (FAST) to discriminate between survivors and nonsurvivors undergoing resuscitative thoracotomy (RT). BACKGROUND:RT is a high-risk, low-salvage procedure performed in arresting trauma patients with poorly ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000001421

    authors: Inaba K,Chouliaras K,Zakaluzny S,Swadron S,Mailhot T,Seif D,Teixeira P,Sivrikoz E,Ives C,Barmparas G,Koronakis N,Demetriades D

    更新日期:2015-09-01 00:00:00

  • Primary hepatocytes outperform Hep G2 cells as the source of biotransformation functions in a bioartificial liver.

    abstract:OBJECTIVE:Metabolic activity of transformed human liver (Hep G2) cells and primary rat hepatocytes were compared during in vitro application of a gel entrapment bioartificial liver. BACKGROUND:Clinical trials of bioartificial liver devices containing either transformed liver cells or primary hepatocytes have been init...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:

    authors: Nyberg SL,Remmel RP,Mann HJ,Peshwa MV,Hu WS,Cerra FB

    更新日期:1994-07-01 00:00:00

  • Recovery of fasted and fed gastrointestinal motility after open versus laparoscopic cholecystectomy in dogs.

    abstract:OBJECTIVE:The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy. SUMMARY BACKGROUND DATA:Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual e...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199604000-00010

    authors: Hotokezaka M,Combs MJ,Mentis EP,Schirmer BD

    更新日期:1996-04-01 00:00:00

  • Hospital Volume of Antireflux Surgery in Relation to Endoscopic and Surgical Re-interventions.

    abstract:OBJECTIVE:To test the hypothesis that higher hospital volume decreases endoscopic and surgical re-intervention rates after antireflux surgery. BACKGROUND:Antireflux surgery for gastro-esophageal reflux disease is followed by varying rates of re-interventions. Whether hospital volume influences re-intervention rates is...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003776

    authors: Markar S,Santoni G,Maret-Ouda J,Artama M,Färkkilä M,Lynge E,Pukkala E,Ness-Jensen E,von Euler-Chelpin M,Lagergren J

    更新日期:2020-01-06 00:00:00

  • The inhibition of aldose reductase attenuates hepatic ischemia-reperfusion injury through reducing inflammatory response.

    abstract:OBJECTIVE:We aim to investigate the role of aldose reductase (AR) in hepatic ischemia-reperfusion injury (IRI) of normal and fatty livers and to explore the underlying mechanisms. BACKGROUND:Hepatic IRI is a typical inflammatory response during liver surgery. It contributes to liver graft failure or nonfunction after ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000000429

    authors: Li CX,Ng KT,Shao Y,Liu XB,Ling CC,Ma YY,Geng W,Qi X,Cheng Q,Chung SK,Lo CM,Man K

    更新日期:2014-08-01 00:00:00

  • Glucose turnover and recycling in colorectal carcinoma.

    abstract::Glucose metabolism is affected by various pathologic states including tumors. In this project, glucose turnover and recycling rates in 11 patients with colorectal carcinoma were measured using a double-labelled 3-3H and 1-14C glucose injection technique. Fasting blood glucose, lactate, pyruvate, alanine, glycerol, 3-h...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198311000-00007

    authors: Kokal WA,McCulloch A,Wright PD,Johnston ID

    更新日期:1983-11-01 00:00:00

  • A multicenter prospective evaluation of the clinical utility of F-18 FDG-PET/CT in patients with AJCC stage IIIB or IIIC extremity melanoma.

    abstract:OBJECTIVE/BACKGROUND:There is a high risk of relapse in stage IIIB/IIIC melanoma. The utility of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography (FDG-PET/CT) in these patients to evaluate response to treatment or for surveillance after treatment is currently not...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0b013e318256d1f5

    authors: Beasley GM,Parsons C,Broadwater G,Selim MA,Marzban S,Abernethy AP,Salama AK,Eikman EA,Wong T,Zager JS,Tyler DS

    更新日期:2012-08-01 00:00:00

  • How Much Weight Loss is Required for Cardiovascular Benefits? Insights From a Metabolic Surgery Matched-cohort Study.

    abstract:OBJECTIVE:The aim of this study was to determine the minimum amount of weight loss required to see a reduction in major adverse cardiovascular events (MACE). BACKGROUND:Although obesity is an established risk factor for morbidity and mortality, the minimum amount of weight loss to have a meaningful impact on cardiovas...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000004369

    authors: Aminian A,Zajichek A,Tu C,Wolski KE,Brethauer SA,Schauer PR,Kattan MW,Nissen SE

    更新日期:2020-10-01 00:00:00

  • Complications of vagotomy in the treatment of hiatal hernia.

    abstract::Inclusion of vagotomy and pyloroplasty in the surgical treatment of gastroesophageal reflux associated with hiatal hernia has long been controversial. To evaluate the morbidity of vagotomy in the treatment of reflux esophagitis, a retrospective study of 311 patients treated by the Hill posterior gastropexy technique o...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197606000-00003

    authors: Vansant JH,Baker JW Jr

    更新日期:1976-06-01 00:00:00

  • Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program.

    abstract:BACKGROUND:Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. METHODS:Patients were identified who underwent colorectal sur...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/sla.0b013e3181b2a948

    authors: Cohen ME,Bilimoria KY,Ko CY,Richards K,Hall BL

    更新日期:2009-12-01 00:00:00

  • Metabolic and hormonal studies comparing three parenteral nutrition regimens in infants.

    abstract::Metabolic and hormonal studies were performed in 6 infants during the first 3 months of life while receiving 3 different types of parenteral nutrition: 1) 20% glucose and a nitrogen source (Dudrick's method) 2) 12% glucose, a nitrogen source and soybean fat emulsion (Intralipid method) and 3) 12% glucose, a nitrogen s...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000658-197507000-00012

    authors: Asch MJ,Sperling M,Fiser R,Leake R,Moore TC,Oh W

    更新日期:1975-07-01 00:00:00

  • Prevention and treatment of central venous catheter sepsis by exchange via a guidewire. A prospective controlled trial.

    abstract::A new approach for preventing and treating sepsis due to central venous catheter (CVC) has been devised at the Istituto Nazionale Tumori of Milan. A prospective protocol has been developed that includes the weekly exchange of the CVC via a guidewire as well as its exchange when a CVC-related sepsis is suspected. Growt...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000658-198307000-00009

    authors: Bozzetti F,Terno G,Bonfanti G,Scarpa D,Scotti A,Ammatuna M,Bonalumi MG

    更新日期:1983-07-01 00:00:00

  • Gallstone pancreatitis: biliary tract pathology in relation to time of operation.

    abstract::During a 29-month trial, 65 patients with acute gallstone pancreatitis were randomly selected for biliary tract explorations either within 73 hours of admission (36 patients) or at three months following remission with nonoperative measures (29 patients, with five others awaiting elective operation). The details of su...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198109000-00008

    authors: Stone HH,Fabian TC,Dunlop WE

    更新日期:1981-09-01 00:00:00