The accuracy of diagnostic peritoneal lavage in penetrating abdominal trauma

BACKGROUND: Penetrating abdominal injuries without clear indication for laparotomy are a dilemma for surgeons. Delayed celiotom increases the morbidity and mortality while unnecessary laparotomies are inefficient. Diagnostic peritoneal lavage (DPL) is re-explored to determine its accuracy in penetrating abdominal trauma. METHODS: All adult patients with penetrating abdominal injuries without indications for laparotomy at the Philippine General Hospital from September 1999 to March 2001 were included in the study. All underwent DPL and standard management in monitoring for penetrating abdominal injuries and await indications for laparotomy. Using various cut-offs for lavage red blood cell count (LRBC) as criteria in interpreting DPL results and, using either intraoperative findings or follow-up patient examination findings (for those who were not operated on) as gold standard, measures of accuracy were estimated. Receiver operating curves (ROC) were generated using various cut-offs ad the most clinically acceptable criteria (cut-offs) were selected. RESULTS: Of the 213 cases, 69% were operated on and the rest where followed up for 2 weeks to determine if there were significant intra-abdominal injuries. The ideal cut-off for LRBC count was greater than or equal to 5000/cu mm (greater than or equal to 5000/cu mm as positive and CONCLUSIONS: DPL may be utilized as part of the selective management of penetrating abdominal injuries without clear indications of laparotomy. Using the LRBC count criterion of 5,000/cu mm, sensitivity is high and the false positive rate is acceptable.

Cashew nut extract (De BCC) in the treatment of basal cell carcinoma

PURPOSE OF THE STUDY: Basal cell carcinoma (BCC) remains as the most common cutaneous neoplasm in the Philippines consisting of more than 60% of all skin cancers. Anacardium occidentale (Linn.) cashew extract, which had been used successfully in the removal of warts and moles in previous studies, is presented as a therapeutic option in BCC. METHODS: An open-label prospective study was conducted on 36 patients (mean age of 65 years) with documented BCC lesions on middle third of the face. Cashew nut extract (DeBCC) application was offered to these patients as an alternative option to very unacceptable extirpative surgery offered by general and plastic surgeons as treatment for their lesions. Lesion size ranged from 7.5- 64 mm. (26.26 mm). Topical treatment was applied every 1-2 weeks, as needed. Follow-up examinations with photographic documentation were made every week to evaluate success of the treatment. RESULTS: After a mean of 7 treatment applications (range of 1-20) all the lesions were undetectable on clinical examinations. Mild tingling sensation, which was reported by all patients during the treatment applications, was tolerable on all occasions. With follow-up ranging from 5-60 months (38.72 months), 16 patients completed the planned 5 - year post-treatment follow-up period. There were no recurrences detected. CONCLUSIONS: Anacardium occidentale (Linn.) cashew extract (DeBCC) presents a viable and acceptable treatment option in primary BCC. The importance of this treatment option could be stressed in patients with lesions not amenable to the prescribed wide margin of resection needed in surgery.

The ozone discotheque fire disaster

To present a critique of the disaster management, the pre-disaster, disaster and post-disaster events surrounding the Ozone Disco fire, the worst land fire disaster in the Philippine history, that occurred on March 19, 1996 were retrieved and summarized from available and verifiable records. The disaster events were analyzed based on the principles of disaster management, particularly in the medical care of the casualties and the operational structures existing in the region at that time. The existing disaster plan of the hospital involved was included in the analysis. Conclusions were set to refocus interest in the disaster and provide basis for planning in disaster preparedness.

Defining the ideal resuscitation strategy for the hypotensive trauma patient

The traditional approach to treatment of posttraumatic hypotension generally follows the principle of aggressive fluid resuscitation espoused by the American College of Surgeons in its Advanced Trauma Life Support course. A number of reports published in the last decade however, have questioned the safety and clinical appropriateness of this traditional approach, with recent data demonstrating support for delayed or limited resuscitation. This review discusses the controversies and presents recommendations for the ideal resuscitation strategy for the Filipino trauma patient with hypotension. (Author)