Duplex ultrasound recognition of spontaneous carotid dissection--a case report and review of the literature.

Spontaneous dissection of the internal carotid artery is an uncommon entity with a variable clinical presentation. A high index of suspicion is required to make the diagnosis, and prompt diagnosis and treatment with anticoagulation are essential for improved patient outcomes. Duplex ultrasound provides a safe and reliable imaging modality for early diagnosis and follow-up. The authors present a case of spontaneous internal carotid artery dissection with duplex ultrasound findings and a review of the literature.

Open abdomen management of intra-abdominal sepsis.

Despite surgical advances, antimicrobial therapy, and intensive care, the morbidity and mortality of intra-abdominal sepsis remains high. The primary purpose of this study was to determine whether open abdomen management of intra-abdominal sepsis reduces intensive care unit (ICU) and hospital mortality. The records of 81 consecutive patients with open abdomen management for intra-abdominal sepsis admitted to the surgical ICU from January 1998 to April 2002 were retrospectively reviewed. Outcomes were compared to a historical control group with primary abdominal closure, also admitted to the surgical ICU with intra-abdominal sepsis and matched for sex, age, source of sepsis, and APACHE III score. ICU mortality for the open abdomen group was 25 per cent versus 17 per cent for the control group. Hospital mortality was 33 per cent and 25 per cent for the open abdomen patients and historical controls, respectively. Both ICU and hospital length of stay were significantly longer for the open abdomen group. An overall fistula rate of 14.8 per cent was demonstrated in the open abdomen patients. A significant difference in overall ICU and hospital mortality was not demonstrated between patients treated with open abdomen management and historical controls. A prospective randomized study accounting for extent of sepsis may define a role for open abdomen management in selected subgroups of patients.