Venous velocity increase with a pneumatic foot compression garment.

Intermittent compression garments have been widely accepted for prophylaxis of deep venous thrombosis. They have broad applicability in both elective and emergent situations. Development of a new type of garment that acts to compress the plantar plexus of the foot provides a potential method of prophylaxis for patients with contraindications to the traditional calf- or thigh-high garments. Evaluation of the ability of the foot compression garment demonstrates a statistically significant increase in peak femoral venous velocity (40.6 cm/sec) as compared with the resting state (25.9 cm/sec). This increase in femoral venous velocity is comparable to that seen with single-cell compression socks. The authors conclude that the recently introduced foot garment produces increases in peak femoral venous velocity similar to those produced by existing garments and that use of the foot compression garment may provide deep venous thrombosis prophylaxis in patients who previously have not been candidates for a compression garment.

Blunt trauma of the diaphragm: a 15-county, private hospital experience.

During a 6-year period, 52 patients with nonpenetrating trauma to the diaphragm were treated in eight acute care hospitals, serving a 15-county area of Michigan. Charts were reviewed to identify patterns of injury, treatment, and outcome. Preoperative diagnosis was made in 50 per cent of cases based on chest x-ray findings; the remainder were diagnosed intraoperatively. Clinical examination revealed respiratory distress, decreased breath sounds, or elevated hemidiaphragm in 81 per cent of patients. Forty-two per cent of patients sustained significant head injuries. Fractures were present in 75 per cent of patients. Major chest injury was found in 92 per cent. Intra-abdominal organs were herniated in 67 per cent of cases with the stomach being most common (54%). The spleen was the most commonly injured abdominal organ (60%). The left diaphragm was injured in 75 per cent of cases; 2 per cent were bilateral. The most common postoperative complication was pneumonia. Mortality in this series was 13 per cent, with no case being related to the diaphragmatic injury. The authors conclude that blunt injuries to the diaphragm in the multiply-injured patient present a clinical diagnostic challenge requiring a high index of suspicion. Optimal care requires a multi-disciplinary critical care team to manage the high incidence of associated central nervous system, orthopedic, and chest injuries and associated high mortality rates.

A simple method for creating subcutaneous tunnels.

A trocar chest tube is an excellent tunneling device. It is readily available in a variety of sizes in all hospitals. It requires no special ordering and is inexpensive. The trocar chest tube glides through subcutaneous tissues easily, resulting in less trauma to the tissue compared with the forceful passage of poorly suited, large, blunt-tipped instruments. Operating room personnel are more likely to be familiar with the location of common trocar chest tubes than infrequently used commercial tunnelers. The option of creating curved tunnels when necessary broadens the applications of this disposable, easy to use instrument.

Microbiological monitoring of aortic aneurysm wall and contents during aneurysmectomy.

Fifty-six patients, ranging in age from 49 to 90 years, underwent abdominal aortic aneurysmectomy and had cultures taken from the aneurysm wall and atheromatous debris to identify possible microbiological sources of future graft infection. All patients received antibiotics before and after operation. Eleven (19.6%) of 56 cultures yielded bacterial growth. The most common organism isolated was Staphylococcus epidermidis (in six of 11 patients). Thirty-seven percent of the aneurysms cultured were symptomatic (expanding or ruptured); however, this group accounted for 54% (6/11) of the positive cultures. During an average follow-up period of 24.5 months (range, four to 82 months), no early or late graft infections were documented. A literature review demonstrated the same disparity between positive cultures obtained at aneurysmectomy and subsequent low graft-infection rate.