RESUMEN
OBJECTIVE: To determine the results of pediatric trauma care managed with a cooperative effort by general surgeons and pediatric intensivists in comparison to national standards. DESIGN: Retrospective chart review. SETTING: Referral level II trauma center in rural Wisconsin. PATIENTS: All pediatric trauma patients age 16 and younger admitted to the hospital from 1990 to 1993. METHODS: Demographics, mechanisms of injury, revised trauma score (RTS), injury severity score (ISS), surgical procedures, need for intensive care, and outcome were examined. All patients were primarily managed by the trauma surgery service. Those patients requiring intensive care were managed jointly by the trauma surgery service and pediatric intensivists. Outcome was predicted by TRISS analysis; patients identified as "unexpected deaths" underwent critical clinical review to determine potential for survival. RESULTS: There were 531 pediatric trauma admissions. The mean age was 9.0 +/- 6.2 (SEM) years and two thirds of the patients were boys. Over half of all injuries were from falls, recreational activities, and motor vehicle crashes. There were few penetrating injuries. The mean RTS was 7.58 +/- 0.05, and the majority of patients had an ISS below 10. Sixty-two percent of patients required surgical procedures, most of which were orthopedic. Fourteen percent of patients were admitted to the pediatric intensive care unit. There were 13 deaths for a mortality rate of 2.4%. TRISS analysis identified six deaths as unexpected. Four drownings were not included in TRISS analysis, and there were no unexpected survivors. Of the six unexpected deaths, there were no significant management errors identified on careful review. CONCLUSIONS: Cooperation between general surgeons and pediatric intensivists can result in excellent pediatric trauma care in a rural level II trauma center.
Asunto(s)
Tratamiento de Urgencia/normas , Hospitales Rurales/normas , Pediatría/normas , Centros Traumatológicos/normas , Heridas y Lesiones/terapia , Accidentes por Caídas/estadística & datos numéricos , Adolescente , Distribución por Edad , Niño , Medicina de Emergencia/organización & administración , Medicina de Emergencia/normas , Femenino , Humanos , Lactante , Masculino , Grupo de Atención al Paciente/organización & administración , Pediatría/organización & administración , Wisconsin/epidemiología , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Heridas y Lesiones/mortalidadAsunto(s)
Neoplasias de las Glándulas Suprarrenales/complicaciones , Aneurisma Roto/complicaciones , Neurofibromatosis/complicaciones , Feocromocitoma/complicaciones , Complicaciones Cardiovasculares del Embarazo , Complicaciones Neoplásicas del Embarazo , Vísceras/irrigación sanguínea , Adulto , Aneurisma Roto/diagnóstico por imagen , Angiografía , Arterias , Duodeno/irrigación sanguínea , Femenino , Humanos , Páncreas/irrigación sanguínea , Embarazo , Radiografía Abdominal , Técnica de Sustracción , Tomografía Computarizada por Rayos XRESUMEN
The Muir-Torre syndrome is a rare autosomal-dominant disease involving sebaceous neoplasms as markers for multiple internal malignancies. Diagnostic criteria include at least one sebaceous gland adenoma, epithelioma, or carcinoma and at least one internal malignancy. The world literature contains 162 cases with 316 internal malignancies. Colorectal and urogenital malignancies predominate, and nearly half the patients had two or more internal cancers. The discovery of a Muir-Torre syndrome-associated sebaceous lesion is rare and should prompt an evaluation for internal malignancies. We report a family over five generations displaying this syndrome. The proband is a 44-year-old man with two skin and two colon malignancies who presented to our clinic with the chief complaint of an infected sebaceous cyst. The world literature is reviewed, and an emphasis on the surgeon's role in evaluation and treatment is discussed.
