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"Benjamin, Elizabeth"
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Visions of glory : the Civil War in word and image
\"This volume collects twenty-two black & white images and twenty-two brisk essays, each essay connecting an image to the events that unfolded during a particular year of the war. Focusing on images that range from a depiction of former slaves whipping their erstwhile overseer distributed by an African American publisher, to a census graph published in the New York Times, to a cutout of a child's hand sent by a southern mother to her husband at the front, the essays in this collection reveal how wartime women and men created both written accounts and a visual register to make sense of the world around them\"-- Provided by publisher.
Book
Preperitoneal Packing for Pelvic Fracture Bleeding Control: A Human Cadaver Study
Background
Preperitoneal packing (PPP) has been widely accepted as a damage control technique for severe bleeding from pelvic fractures. It is supposed to work by direct compression and tamponade of the bleeding source in the pelvis and it has been suggested to be effective for both venous and arterial bleeding. However, there is little evidence to support its efficacy or the ability to place the laparotomy pads in proximity of the desired location.
Methods
Bilateral PPP was performed on 10 fresh human cadavers, followed by laparotomy and measurements of resultant pad placement in relation to critical anatomic structures.
Results
A total of 20 assessments of laparotomy pad placement were performed. Following completion of PPP, a midline laparotomy was performed to determine proximity and closest distance of the laparotomy pads to sites of potential bleeding in pelvic fractures. In almost all cases, the pad placement was not contiguous with the key anatomic structure with mean placement 3.9 + 1.1 cm from the sacroiliac joint, 3.5 + 1.6 cm from the common iliac artery, 1.1 + 1.2 cm from the external iliac artery, 2.8 + 0.8 cm from the internal iliac artery, and 2.3 + 1.2 cm from the iliac bifurcation. Surgeon experience resulted in improved placement relative to the sacroiliac joint, however the pads still did not directly contact the target point.
Conclusion
This human cadaver study has shown that PPP, even in experienced hands, may not be placed in significant proximity of anatomical structures of interest. The role of PPP needs to be revisited with better clinical or human cadaver studies.
Journal Article
Climate change in human history : prehistory to the present
\"Climate Change and Human History provides an up-to-date and concise introduction to the relationship between human beings and climate change throughout history. Starting with periods hundreds of thousands of years ago and continuing up to the present day, the book illustrates how natural climate variability affected early human societies, and how humans are now altering climate drastically within much shorter periods of time. For each major period of time, the book will explain how climate change has created opportunities as well as risks and challenges for human societies. The book introduces and develops several related themes including: Phases of climate and history; factors that shape climate; climate shocks and sharp climate shifts; climate and the rise and fall of civilizations; industrialization and climate science; [and] accelerating climate change, human societies, and the future. An ideal companion for all students of environmental history, Climate Change and Human History clearly demonstrates the critical role of climate in shaping human history and of the experience of humans in both adapting to and shaping climate change.\" -- Publisher's description
Book
Injury Patterns and Treatment Strategies in Civilian and Military Isolated Abdominal Gunshot Wounds
Background
Combat-related gunshot wounds (GSW) may differ from those found in civilian trauma centers. Missile velocity, resources, logistics, and body armor may affect injury patterns and management strategies. This study compares injury patterns, management, and outcomes in isolated abdominal GSW between military (MIL) and civilian (CIV) populations.
Methods
The Department of Defense Trauma Registry (DoDTR) and TQIP databases were queried for patients with isolated abdominal GSW from 2013 to 2016. MIL patients were propensity score matched 1:3 based on age, sex, and extraabdominal AIS. Injury patterns and in-hospital outcomes were compared. Initial operative management strategies, including selective nonoperative management (SNOM) for isolated solid organ injuries, were also compared.
Results
Of the 6435 patients with isolated abdominal GSW, 183 (3%) MIL were identified and matched with 549 CIV patients. The MIL group had more hollow viscus injuries (84% vs. 66%) while the CIV group had more vascular injuries (10% vs. 21%) (
p
< .05 for both). Operative strategy differed, with more MIL patients undergoing exploratory laparotomy (95% vs. 82%) and colectomy (72% vs. 52%) (
p
< .05 for both). However, no difference in ostomy creation was appreciated. More SNOM for isolated solid organ injuries was performed in the CIV group (34.1% vs. 12.5%;
p
< 0.05). In-hospital outcomes, including mortality, were similar between groups.
Conclusions
MIL abdominal GSW lead to higher rates of hollow viscus injuries compared to CIV GSW. MIL GSW are more frequently treated with resection but with similar ostomy creation compared to civilian GSW. SNOM of solid organ injuries is infrequently performed following MIL GSW.
Journal Article
The effects of body mass index on complications and mortality after emergency abdominal operations: The obesity paradox
Recent literature suggests that obesity is protective in critically illness. This study addresses the effect of BMI on outcomes after emergency abdominal surgery (EAS).
Retrospective, ACS-NSQIP analysis. All patients that underwent EAS were included. The study population was divided into five groups based on BMI; regression models were used to evaluate the role of obesity in morbidity and mortality.
101,078 patients underwent EAS; morbidity and mortality were 19.5% and 4.5%, respectively. Adjusted mortality was higher in underweight patients (AOR 1.92), but significantly lower in all obesity groups (AOR's 0.73, 0.66, 0.70, 0.70 respectively). Underweight and class III obesity was associated with increased complications (AOR 1.47 and 1.30), while mild obesity was protective (AOR 0.92).
Underweight patients undergoing EAS have increased morbidity and mortality. Although class III obesity is associated with increased morbidity, overweight and class I obesity were protective. All grades of obesity may be protective against mortality after EAS relative to normal weight patients.
Journal Article
Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study
Despite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma.
The TQIP database (2013–2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups.
After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13–27] vs. 15 [9–25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups.
Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.
•Protecting a colon anastomosis with diverting ostomy may not prevent complications.•More local infectious complications are seen with diverting ostomy in colon trauma.•Diverting ostomy creation may lead to increased length of stay.
Journal Article
Preperitoneal pelvic packing in isolated severe pelvic fractures is associated with higher mortality and venous thromboembolism: A matched-cohort study
Preperitoneal pelvic packing (PPP) has been advocated as a damage control procedure for pelvic fracture bleeding, despite of weak evidence.
Matched cohort study, TQIP database. Patients with isolated severe blunt pelvic fractures (pelvis abbreviated injury score [AIS] ≥ 3, AIS ≤2 in all other body regions) were included. Patients who underwent PPP were matched to patients with no PPP, 1:3 nearest propensity score. Matching was performed based on demographics, vital signs on admission, comorbidities, injury characteristics, type and timing of initiation of VTE prophylaxis, and additional procedures including laparotomy, REBOA, and angioembolization.
64 patients with PPP were matched with 182 patients with No-PPP. PPP patients had higher in-hospital mortality (14.1 % vs 2.2 % p < 0.001) and higher rates of VTE and DVT (VTE: 14.1 % vs 4.4 % p = 0.018, DVT: 10.9 % vs 2.2 % p = 0.008).
PPP is associated with worse survival outcomes and increased rate of VTE and DVT complications.
Preperitoneal Packing in Pelvic Fractures.•Higher Mortality•Higher incidence of venous thromboembolic complications.
Journal Article