ABSTRACT
The financial realities of the current health care arena make it imperative that deliverers of trauma care initiate programs that reduce the cost of trauma. Triage can be one process that attempts to attain this goal. Once patients are assigned to a Level I trauma center, it is possible to triage patients again to complement field triage. A two-tiered, inhospital trauma response system was developed in which different team responses are initiated depending on the patient status. This tiered, in-house response system differs with respect to human and material resources. Personnel, operating room, laboratory work, and protective wear savings account for approximately $1,042 per code patient, yielding an annual $629,404 institutional savings.
Subject(s)
Emergency Medical Services/economics , Triage/economics , Wounds and Injuries/therapy , Cost Control , Humans , Resuscitation , Trauma Centers , Virginia , Wounds and Injuries/classificationABSTRACT
A sacrococcygeal adenocarcinoma is reported in a male patient nearly 40 years old following resection of a histologically mature sacrococcygeal teratoma. The adenocarcinoma arose within soft tissue of the presacral area and residual coccyx and extensively invaded the coccygeal stump that had not been removed in toto with the teratoma during initial surgery at 2 months of age. The patient died nearly 2 years later with local and regional recurrence of tumor and metastases to lymph nodes, liver, lung, bone, and brain. At autopsy there was no evidence of origin from deep internal organs such as the stomach, pancreas, or other sites. Brief comments are made about malignant tumors complicating sacrococcygeal teratomas in both the pediatric age group and adults, and attention is focused on other lesions entering into the differential diagnosis, particularly retrorectal cyst/hamartoma or tailgut cysts. This case underscores an extremely rare but potentially fatal outcome of a patient with sacrococcygeal teratoma.
Subject(s)
Adenocarcinoma/pathology , Neoplasms, Second Primary/pathology , Sacrococcygeal Region , Soft Tissue Neoplasms/pathology , Teratoma/pathology , Adult , Humans , Male , Time FactorsABSTRACT
Acute gastric volvulus in children is uncommon. Since 1899, only 77 cases have been documented in the world literature. In children, mesenteroaxial volvulus is the most common type and associated anatomic defects are the rule. Diagnostic delays result in gastric ischemia, perforation, and death. Nonoperative mortality is 80%. Early recognition, surgical reduction with gastric fixation, and repair of associated defects are the mainstays of therapy for acute gastric volvulus in the pediatric population.