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Splenic Injury

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1341. Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. (PubMed)

Argon beam coagulation is superior to conventional techniques in repair of experimental splenic injury. Present management of splenic trauma focuses on splenic preservation. However, conventional operative techniques for splenic salvage are time consuming and frequently ineffective. The purpose of this study was to assess the efficacy of the argon beam coagulator (ABC) in the management of experimental splenic injury. Ten adult miniature pigs were randomized to treatment with either (...) conventional surgical techniques (topical Surgicel, electrocautery, suture-ligation, digital pressure) or splenic repair with the ABC. Three standard splenic injuries were made in each pig: capsular avulsion, splenic laceration, and hemisplenectomy. The ABC was more effective in treating all three types of splenic injury. The time required to achieve hemostasis and total operative time were significantly less in the group treated with the ABC for all three types of splenic injuries (p less than 0.05

1991 Journal of Trauma

1342. Management outcomes in splenic injury: a statewide trauma center review. (PubMed)

Management outcomes in splenic injury: a statewide trauma center review. Clinical pathways now highlight both observation and operation as acceptable initial therapeutic options for the management of patients with splenic injury. The purpose of this study was to evaluate treatment trends for splenic injury in all North Carolina trauma centers over a 6-year period.Splenic injuries in adults over a 6-year period (January 1988-December 1993) were identified in the North Carolina Trauma Registry (...) injury. Resource utilization (length of stay, hospital charges) and outcome (mortality) were compared.One thousand two hundred fifty-five patients were identified with splenic injury. Rate of splenic preservation increased over time and was achieved in more than 50% of patients through nonoperative management (40%) and splenorrhaphy (12%). Splenorrhaphy was not used commonly in either blunt or penetrating injury. Overall mortality was 13%. Geriatric patients had a higher mortality and resource

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1997 Annals of Surgery

1343. Management of splenic injuries in a Canadian trauma centre (PubMed)

Management of splenic injuries in a Canadian trauma centre To document the current practice pattern for the treatment of splenic injuries in one Canadian trauma centre and to identify factors that determined which method was employed.A cohort study.A Canadian lead trauma centre.A cohort of 100 patients with splenic injury treated at one trauma hospital over 5 years was identified from a prospective trauma database.The success rate and failure rate for splenic salvage by splenectomy (...) , splenorrhaphy or observation. Volume of blood transfused, injury severity score (ISS) and method of diagnosis.The median ISS for the cohort was 34 (36 for splenectomy, 38 for splenorrhaphy and 35 for observation). A blunt mechanism of injury was present in 96%. The diagnosis was made by computed tomography (CT) in 55%. Splenic salvage was accomplished in 51 patients; of these, 44 (86%) were in the observation group, and the success rate was 90% (within the range reported in the literature). Only seven

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1996 Canadian Journal of Surgery

1344. Nonoperative management of blunt hepatic and splenic injury in children. (PubMed)

Nonoperative management of blunt hepatic and splenic injury in children. The authors assessed the risks of nonoperative management of solid visceral injuries in children (age range, 4 months-14 years) who were consecutively admitted to a level I pediatric trauma center during a 6-year period ending in 1991.One hundred seventy-nine children (5.0%) sustained injury to the liver or spleen. Nineteen children (11.2%) died. Of the 160 children who survived, 4 received emergency laparotomies; 156 (...) underwent diagnostic computer tomography and were managed nonoperatively. The percentage of children who were successfully treated nonoperatively was 97.4%. Delayed diagnosis of enteric perforations occurred in two children. Fifty-three children (34.0%) received transfusions (mean volume 16.7 mL/kg); however, transfusion rates during the latter half of the study decreased from 50% to 19% in children with hepatic injuries, despite increasing grade of injury, and decreased from 57% to 23% in the splenic

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1996 Annals of Surgery

1345. Management of adult splenic injuries in Ontario: a population-based study (PubMed)

Management of adult splenic injuries in Ontario: a population-based study To determine the population-based incidence of splenic injuries in the Province of Ontario, the proportion of splenic injuries treated by observation, splenectomy and splenorrhaphy, changes in management over time and the variation in management of splenic injuries among Ontario hospitals.A retrospective cohort study.All adults (older than 16 years) admitted with a diagnosis of splenic injury (clinical modification (...) of the International Classification of Diseases, 9th revision) to acute care hospitals in Ontario between 1991 and 1994, identified from the Ontario Trauma Registry.The incidence of splenic injury was 1.7 cases per 1000 trauma admissions per year. Patients with splenic injury were young (median age 32 years) and male (71%), and the death rate was 8%. Observation was the commonest method of treatment (69%), followed by splenectomy (28%) and splenorrhaphy (4%). The use of observation increased over the study period

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2000 Canadian Journal of Surgery

1346. Occult splenic injury: delayed presentation manifesting as jaundice (PubMed)

Occult splenic injury: delayed presentation manifesting as jaundice Delayed splenic rupture, though uncommon, is a recognised clinical condition and is associated with a significant mortality rate. In the vast majority of cases the patient re-presents with abdominal symptoms and/or signs of acute intraperitoneal haemorrhage. A case is presented of delayed splenic rupture presenting with jaundice attributable to intra-abdominal clot lysis.

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2001 Emergency Medicine Journal : EMJ

1347. Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline (PubMed)

Blunt splenic injuries in a Canadian pediatric population: the need for a management guideline To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries.A chart review.Winnipeg Children's Hospital.All patients with splenic injuries under the age of 17 years admitted to the hospital between December 1994 and April 1999.These included patient demographics, length of stay, location of care, grade of splenic (...) injury (American Association for the Surgery of Trauma Organ Injury Scale), imaging tests performed in hospital and after discharge, follow-up care and time to return to full activity.Forty-four patients received nonoperative management. The mean age of the patients was 10.4 years. The average grade of splenic injury was 2.8. Sixteen patients (36%) were admitted to the intensive care unit for an average of 1.9 days. Mobilization was allowed after a mean of 5.2 days. Average length of hospital stay

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2002 Canadian Journal of Surgery

1348. Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients. (PubMed)

Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients. During the past decade splenic salvage procedures rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic preservation has been most often accomplished by splenorrhaphy and more recently by a controversial nonoperative approach. This report delineates indications, contraindications, and results with splenectomy, splenorrhaphy, and nonoperative (...) treatment based on an 11-year experience (1978 to 1989) in which 193 consecutive adult patients with splenic injuries were treated. One hundred sixty-seven patients (86.5%) underwent urgent operation. Of these, 111 (66%) were treated by splenorrhaphy or partial splenectomy and 56 (34%) were treated by splenectomy. During the last 4 years, 26 additional patients (13.5%) were managed without operation. Patients considered for nonoperative treatment were alert, hemodynamically stable with computed

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1990 Annals of Surgery

1349. Evaluation of splenic injury by computed tomography and its impact on treatment. (PubMed)

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

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1990 Annals of Surgery

1350. Non-operative management of blunt splenic injury. (PubMed)

Non-operative management of blunt splenic injury. 1855039 1991 08 26 2018 11 13 0959-8138 302 6792 1991 Jun 29 BMJ (Clinical research ed.) BMJ Non-operative management of blunt splenic injury. 1553-4 Gibney E J EJ eng Editorial England BMJ 8900488 0959-8138 AIM IM BMJ. 1991 Jul 20;303(6795):188 1760011 Adult Child Humans Methods Spleen injuries Splenic Rupture therapy Wounds, Nonpenetrating therapy 1991 6 29 1991 6 29 0 1 1991 6 29 0 0 ppublish 1855039 PMC1670357 Bruns Beitr Klin Chir. 1964 Jun

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1991 BMJ : British Medical Journal

1351. Updating the management of salvageable splenic injury. (PubMed)

Updating the management of salvageable splenic injury. Because of the ready availability of autotransfusers and risk of transfusion-transmitted disease, the authors reexamined the management of splenic trauma. During the past 6 months, 20 adult and pediatric patients were treated for blunt splenic trauma. Nine had "minor" lacerations and were successfully managed nonoperatively. Eleven had ongoing hemorrhage or associated visceral injury necessitating laparotomy. In two, coexistent injuries (...) were life threatening and total splenectomy was performed. The other nine had major splenic trauma that was either an isolated phenomenon or was associated with an injury not jeopardizing survival; eight spleens were salvaged. Mean intra-abdominal blood loss was approximately 1250 mL and, using a "cell saver," an average of approximately 790 mL was reinfused. Six received no other blood transfusion whereas three received 2250 mL homologous blood in addition to 4250 mL via the "cell-saver

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1992 Annals of Surgery

1352. Non-operative management of blunt splenic injury. (PubMed)

Non-operative management of blunt splenic injury. 1760011 1991 10 03 2018 11 13 0959-8138 303 6795 1991 Jul 20 BMJ (Clinical research ed.) BMJ Non-operative management of blunt splenic injury. 188 Fitzgerald R R eng Letter Comment England BMJ 8900488 0959-8138 AIM IM BMJ. 1991 Jun 29;302(6792):1553-4 1855039 Humans Spleen injuries Tomography, X-Ray Computed Wounds, Nonpenetrating diagnostic imaging 1991 7 20 1991 7 20 0 1 1991 7 20 0 0 ppublish 1760011 PMC1670409 BMJ. 1991 Jun 29;302(6792):1553

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1991 BMJ : British Medical Journal

1353. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important? (PubMed)

Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important? 20852694 2011 07 14 2016 10 21 1948-3384 2 3 2001 Jul The California journal of emergency medicine Cal J Emerg Med Clinical findings in patients with splenic injuries: are injuries to the left lower chest important? 33-6 Schneir A A Division of Emergency Medicine, UC San Diego School of Medicine and. Holmes J F JF eng Journal Article United States Cal J Emerg Med 101527253 1948-3384 2010 9 21 6

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2001 The California Journal of Emergency Medicine

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