Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study.

Abstract:

OBJECTIVE:The primary aim of this study was to delineate the role of computed tomography (CT) in patients undergoing NOM for AGSW. BACKGROUND:Nonoperative management (NOM) of abdominal gunshot wounds (AGSWs) remains controversial. METHODS:This prospective study included all patients with abdominal gunshot injuries admitted to our trauma center from April 1, 2004 to September 30, 2009. Exclusion criteria included patients with peritonitis, hemodynamic instability, unreliable physical examination, head and spinal cord injury with an AGSW underwent immediate laparotomy. The remaining patients were selected for NOM. Nonperitonitic stable patients with right-sided thoracoabdominal/right upper quadrant gunshots and/or hematuria underwent mandatory CT with intravenous contrast. CT to detect missile trajectory was optional. The primary outcome measure was failure of NOM. Secondary outcomes were unnecessary laparotomy rates and mortality. RESULTS:A total of 1106 patients with abdominal gunshot injuries were admitted. Of these, 834 (75.4%) underwent immediate laparotomy, whereas 272 (24.6%) were selected for NOM. In the former group, there were 56 (6.7%) deaths and 29 (3.5%) unnecessary laparotomies, whereas in the latter NOM group, 82 (30.1%) patients were managed by serial clinical examination alone, whereas 190 (69.9%) patients underwent abdominal CT scanning, in addition to serial clinical examination. The overall NOM success rate was 95.2%. Of the 13 patients undergoing delayed laparotomy, there were 10 therapeutic, 2 nontherapeutic, and 1 negative laparotomy. CONCLUSIONS:The NOM of appropriately selected patients with AGSW with selective use of CT scanning is feasible, safe, and effective, but largely based on findings from serial clinical examinations.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Navsaria PH,Nicol AJ,Edu S,Gandhi R,Ball CG

doi

10.1097/SLA.0000000000000879

subject

Has Abstract

pub_date

2015-04-01 00:00:00

pages

760-4

issue

4

eissn

0003-4932

issn

1528-1140

journal_volume

261

pub_type

临床试验,杂志文章
  • Postoperative function of "free" jejunal transplants for replacement of the cervical esophagus.

    abstract::The postoperative function of "free" jejunal autotransplants for replacement of the pharyngoesophagus after palliative resection was evaluated in nine patients using clinical assessment, cinefluoroscopy, manometry, and electrical studies. After an initial period of adjustment, all patients swallowed solids and liquids...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198010000-00002

    authors: Meyers WC,Seigler HF,Hanks JB,Thompson WM,Postlethwait R,Jones RS,Akwari OK,Cole TB

    更新日期:1980-01-01 00:00:00

  • A new type of sliding hiatus hernia.

    abstract::A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. Th...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198508000-00004

    authors: Myllärniemi H,Saario I

    更新日期:1985-08-01 00:00:00

  • Intraperitoneal povidone-iodine in experimental peritonitis.

    abstract::Two experimental models were utilized to study the efficacy of intraperitoneal povidone-iodine in an established peritonitis. In both models, there was a 100% mortality in the povidone-iodine treated group. In laboratories which have reported favorable results, the animals were treated before peritonitis was allowed t...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197806000-00005

    authors: Lagarde MC,Bolton JS,Cohn I Jr

    更新日期:1978-06-01 00:00:00

  • Effect of resection margins on the recurrence of Crohn's disease in the small bowel. A randomized controlled trial.

    abstract:OBJECTIVE:The authors assess the effect of surgical margin width on recurrence rates after intestinal resection of Crohn's Disease (CD). BACKGROUND:The optimal width of margins when resecting DC of the small bowel is controversial. Most studies have been retrospective and have had conflicting results. METHODS:Patient...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000658-199610000-00014

    authors: Fazio VW,Marchetti F,Church M,Goldblum JR,Lavery C,Hull TL,Milsom JW,Strong SA,Oakley JR,Secic M

    更新日期:1996-10-01 00:00:00

  • Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995.

    abstract::Twenty-seven patients with postoperative enterocutaneous fistulas were treated with parenteral nutrition and SMS 201-995 (100 micrograms/8 hours, subcutaneously), a long half-life somatostatin analogue. At the time SMS 201-995 was started, 11 patients had low output fistulas (less than 1000 ml/48 hours), 11 patients h...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198907000-00009

    authors: Nubiola P,Badia JM,Martinez-Rodenas F,Gil MJ,Segura M,Sancho J,Sitges-Serra A

    更新日期:1989-07-01 00:00:00

  • Multiple systems organ failure. Modulation of hepatocyte protein synthesis by endotoxin activated Kupffer cells.

    abstract::The etiology of hepatic insufficiency associated with the multiple systems organ failure (MSOF) syndrome is unclear. The authors have investigated the possibility that a macrophage/Kupffer cell mediated modulation of hepatocyte function may play a role in this phenomenon. Isolated rat hepatocytes were cultured, and th...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:

    authors: Keller GA,West MA,Cerra FB,Simmons RL

    更新日期:1985-01-01 00:00:00

  • Experimental gastric sympathectomy: an effective prophylaxis of gastric stress lesions.

    abstract::Fifteen mini-pigs were bled to a mean aortic blood pressure of 40 mm Hg and maintained at that level for three hours. The control group consisted of eight animals with shock for three hours, while the test group was comprised of seven animals with a similar shock period but which had undergone splanchnicectomy 14 days...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197712000-00019

    authors: Hottenrott C,Seufert RM,Kühne FW,Büsing M

    更新日期:1977-12-01 00:00:00

  • Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients.

    abstract::From July 1983 through December 1987, 300 consecutive patients with penetrating gunshot wounds of the abdomen causing visceral or vascular injuries were treated. Resuscitative thoracotomy was required in 20 patients (6.6%), and only two survived. The most commonly injured organs were the small bowel (60%), colon (41.6...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198809000-00014

    authors: Feliciano DV,Burch JM,Spjut-Patrinely V,Mattox KL,Jordan GL Jr

    更新日期:1988-09-01 00:00:00

  • Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study.

    abstract:OBJECTIVES:Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. METHODS:Twenty...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/01.sla.0000234932.88487.75

    authors: Chaer RA,Derubertis BG,Lin SC,Bush HL,Karwowski JK,Birk D,Morrissey NJ,Faries PL,McKinsey JF,Kent KC

    更新日期:2006-09-01 00:00:00

  • Retained and recurrent bile duct stones. Surgical or nonsurgical removal?

    abstract::An experience with 69 patients who underwent 72 common bile duct reoperations for retained or recurrent choledocholithiasis is presented. The mean age of the patients was 57 years, and 35 patients had associated conditions. In this series six patients (8.3%) had minor complications and no patient developed major compl...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198102000-00004

    authors: Girard RM,Legros G

    更新日期:1981-02-01 00:00:00

  • Vein cuff interposition prevents juxta-anastomotic neointimal hyperplasia.

    abstract::This study sought to minimize juxta-anastomotic neointimal hyperplasia (JNIH) following the use of polytetrafluorethylene (PTFE) conduits. PTFE anastomoses to canine carotid arteries (noncuff grafts) were compared with grafts with vein cuffs interposed proximally and distally between the graft and native artery. This ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198806000-00011

    authors: Suggs WD,Henriques HF,DePalma RG

    更新日期:1988-06-01 00:00:00

  • Liver transplantation for nonresectable liver metastases from colorectal cancer.

    abstract:OBJECTIVE:The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs). BACKGROUND:Patients with nonresectable CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章

    doi:10.1097/SLA.0b013e3182823957

    authors: Hagness M,Foss A,Line PD,Scholz T,Jørgensen PF,Fosby B,Boberg KM,Mathisen O,Gladhaug IP,Egge TS,Solberg S,Hausken J,Dueland S

    更新日期:2013-05-01 00:00:00

  • Optimizing Surveillance and Re-intervention Strategy Following Elective Endovascular Repair of Abdominal Aortic Aneurysms.

    abstract:BACKGROUND:EVAR for abdominal aortic aneurysm has an initial survival advantage over OR, but more frequent complications increase costs and long-term aneurysm-related mortality. Randomized controlled trials of EVAR versus OR have shown EVAR is not cost-effective over a patient's lifetime. However, in the EVAR-1 trial, ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003625

    authors: Kim LG,Sweeting MJ,Epstein D,Venermo M,Rohlffs FEV,Greenhalgh RM

    更新日期:2019-10-07 00:00:00

  • Parathyroid re-exploration. A clinical and pathological study of 112 cases.

    abstract::In a series of 112 patients who underwent reoperation for primary hyperparathyroidism at the Massachusetts General Hospital between 1930 and 1975, all but 10 were treated successfully. Seventy-five initial explorations had been performed elsewhere, and 37 in our hospital. A total of 110 diseased parathyroids were unco...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197708000-00004

    authors: Wang CA

    更新日期:1977-08-01 00:00:00

  • Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

    abstract:OBJECTIVE:To evaluate the short-term outcomes for laparoscopic Roux-en-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months. SUMMARY BACKGROUND DATA:The Roux-en-Y gastric bypass is a highly successful approach to morbid obesity but results in significant perioperative complications. A laparoscopic appro...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-200010000-00007

    authors: Schauer PR,Ikramuddin S,Gourash W,Ramanathan R,Luketich J

    更新日期:2000-10-01 00:00:00

  • Perforated stress ulcer in infants: a silent threat.

    abstract::Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197912000-00006

    authors: Adeyemi SD,Ein SH,Simpson JS

    更新日期:1979-12-01 00:00:00

  • TransCarotid Revascularization with Dynamic Flow reversal versus Carotid Endarterectomy in the Vascular Quality Initiative Surveillance Project.

    abstract:OBJECTIVE:To compare the outcomes of TransCarotid Artery Revascularization with flow reversal (TCAR) to the gold standard carotid endarterectomy (CEA) using data from the Society for Vascular Surgery Vascular Quality Initiative TCAR Surveillance Project. SUMMARY BACKGROUND DATA:TCAR is a novel minimally invasive proce...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000004496

    authors: Malas MB,Dakour-Aridi H,Kashyap VS,Eldrup-Jorgensen J,Wang GJ,Motaganahalli RL,Cronenwett JL,Schermerhorn ML

    更新日期:2020-09-15 00:00:00

  • Duodenal switch provides superior weight loss in the super-obese (BMI > or =50 kg/m2) compared with gastric bypass.

    abstract:OBJECTIVES:Although weight loss following Roux-en-Y gastric bypass is acceptable in patients with preoperative body mass index (BMI) between 35 and 50 kg/m, results from several series demonstrate that failure rates approach 40% when BMI is > or =50 kg/m. Here we report the first large single institution series directl...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/01.sla.0000239086.30518.2a

    authors: Prachand VN,Davee RT,Alverdy JC

    更新日期:2006-10-01 00:00:00

  • Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial.

    abstract:OBJECTIVE:Using a prospective randomized study to assess postoperative morbidity and pancreatic function after pancreaticoduodenectomy with pancreaticojejunostomy and duct occlusion without pancreaticojejunostomy. SUMMARY BACKGROUND DATA:Postoperative complications after pancreaticoduodenectomy are largely due to leak...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000658-200210000-00004

    authors: Tran K,Van Eijck C,Di Carlo V,Hop WC,Zerbi A,Balzano G,Jeekel H

    更新日期:2002-10-01 00:00:00

  • Vein replacement with fresh vital veins: a comparison of transplantation in RT-1-different rat strain combinations.

    abstract::Transplantation of the intrathoracic inferior vena cava into the abdominal inferior vena cava of the recipient was performed in inbred rat strains of the following combinations: Syngeneic F344 leads to F344, RT-1-identical allogeneic LEW leads to F344, and RT-1-different allogeneic CAP leads to F344. In the RT-1-diffe...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198103000-00006

    authors: Thiede A,Engemann R,Korner HH,Deltz E,Muller-Ruchholtz W

    更新日期:1981-03-01 00:00:00

  • Ultrasound in renal transplantation.

    abstract::Because of important differences in prognosis and treatment, prompt and accurate diagnosis of fever, decreasing function, and pain and tenderness around a renal allograft is crucial for differentiation between acute rejection and other post-operative conditions which may give a similar picture. Ultrasound examinations...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197704000-00012

    authors: Petrek J,Tilney NL,Smith EH,Williams JS,Vineyard GC

    更新日期:1977-04-01 00:00:00

  • Effect of moderate hypothermia in the treatment of canine hemorrhagic shock.

    abstract::This study evaluated a possible protective and therapeutic effect of moderate hypothermia in the treatment of severe hemorrhagic shock. A modified Wiggers shock preparation was used. Normothermic dogs (Group I, N = 6) were maintained at normal body temperature throughout hemorrhagic shock and resuscitation. In Group I...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198804000-00015

    authors: Meyer DM,Horton JW

    更新日期:1988-04-01 00:00:00

  • Parasympathetic innervation and pancreatic secretion: the role of the gastric antrum.

    abstract::The role of the antrum on vagally mediated pancreatic secretion was studied in 8 conscious dogs prepared with chronic pancreatic and gastric fistulae. After completion of control studies 6 were subjected to antrectomy and 2 to antroneurolysis (to interrupt submucosal nerve connections); secretory studies were repeated...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197603000-00005

    authors: Rosenberg IR,Zambrano VJ,Janowitz HD,Rudick J

    更新日期:1976-03-01 00:00:00

  • The advantages of 131I-orthoiodohippurate scintiphotography in the management of patients after renal transplantation.

    abstract::Renal scintiphotography with (131)I-hippurate was the primary diagnostic procedure in evaluating renal failure and complications in over 500 transplant patients. This diagnostic test has become our principal method of evaluation and followup of renal transplants, especially in the early post-transplant period. It has ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197409000-00014

    authors: Salvatierra O Jr,Powell MR,Price DC,Kountz SL,Belzer FO

    更新日期:1974-09-01 00:00:00

  • True Short Esophagus in Gastro-esophageal Reflux Disease: Old Controversies With New Perspectives.

    abstract::MINI: In cases of true short esophagus diagnosed intraoperatively with an endoscopic-laparoscopic method, Collis-Nissen and stomach around stomach fundoplication procedures achieved similar results. The notion that the gastric fundus must be wrapped around a conveniently long segment of the tubular esophagus to obtain...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003582

    authors: Lugaresi M,Mattioli B,Daddi N,Bassi F,Pilotti V,Ferruzzi L,Mattioli S

    更新日期:2019-09-03 00:00:00

  • The effect of complications on length of stay.

    abstract:OBJECTIVES:The authors determined the effect of complications on length of stay (LOS) in surgical patients. SETTING:From 1987 to 1990, in the Professional General Surgical Unit of Royal Victoria Hospital, a retrospective survey was conducted on 5128 consecutively admitted patients with 396 different diagnosis; 228 dif...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199412000-00006

    authors: McAleese P,Odling-Smee W

    更新日期:1994-12-01 00:00:00

  • Studies in fetal wound healing. V. A prolonged presence of hyaluronic acid characterizes fetal wound fluid.

    abstract::Midgestation fetal wound healing is characterized by healing without fibrosis or scar formation. The mechanisms that underlie this remarkable process are mediated in part through a fetal wound extracellular matrix rich in hyaluronic acid. In this study a newly developed assay was used to determine the hyaluronic acid ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199104000-00003

    authors: Longaker MT,Chiu ES,Adzick NS,Stern M,Harrison MR,Stern R

    更新日期:1991-04-01 00:00:00

  • The evolution of the concept of the use of surgical castration in the palliation of breast cancer in pre-menopausal females.

    abstract::The understanding of the association of mammalian ovarian function with lactation was common knowledge to dairy-men early in the 19th century or earlier. This thesis reviews the application of these empiric observations to lactation in humans by Beatson of Glasgow, supported by his preliminary laboratory investigation...

    journal_title:Annals of surgery

    pub_type: 传,历史文章,杂志文章

    doi:10.1097/00000658-197612000-00009

    authors: Macmahon CE,Cahill JL

    更新日期:1976-12-01 00:00:00

  • A Clinical Nomogram for Predicting Node-positive Disease in Esophageal Cancer.

    abstract:OBJECTIVE:We developed and validated a nomogram predicting the likelihood of occult lymph node metastases in surgically resectable esophageal cancers. BACKGROUND:Patients with esophageal cancer with positive lymph nodes benefit from neoadjuvant therapy, but limitations in current clinical staging techniques mean nodal...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000003450

    authors: Semenkovich TR,Yan Y,Subramanian M,Meyers BF,Kozower BD,Nava R,Patterson GA,Kreisel D,Puri V

    更新日期:2019-07-03 00:00:00

  • Prognostic Implications of Pathological Response to Neoadjuvant Chemoradiation in Pathologic Stage III Rectal Cancer.

    abstract:OBJECTIVE:To evaluate the independent prognostic ability of the American Joint Committee on Cancer (AJCC) tumor regression scores within pathologic stage II and III rectal cancers. BACKGROUND:Response to neoadjuvant chemoradiation (nCRT) has been debated as a biologic surrogate for tumor biology and prognosis in recta...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000002719

    authors: Karagkounis G,Thai L,Mace AG,Wiland H,Pai RK,Steele SR,Church JM,Kalady MF

    更新日期:2019-06-01 00:00:00