• During a 10-year wound infection surveillance program, 1032 wound infections complicated 40 915 operations. Surveillance continued for 30 days postoperatively, and rigid clinical criteria for diagnosis were honored. Operations were distributed unequally among infection risk classes: clean (class I), 63.3%; clean contaminated (class II), 26.4%; and contaminated (class III) 10.3%. Infections occurred with nearly equal frequencies among classes: I, 36.1%; II, 29.5%; and III, 34.4%. Wound infection rates during the 10-year period were 2.5% (all operations), 1.4% (class I), 2.8% (class II), and 8.4% (class III). Index year (1977) infection rates were 4.2% (all operations), 2.3% (class I), 5.4% (class II), and 12.8% (class III). Wound infection rates during the last 9 years of surveillance in every risk class were significantly less than index year rates, representing infection rate decreases of 38% to 56%. Estimated savings in hospital room costs alone reached $3 million during 10 years. (Arch Surg. 1990;125:794-803)
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Cutaneous metastatic carcinoma of the nose is a rare presentation associated with lung cancer. We report here 3 cases of cutaneous metastatic carcinoma of the nose that originated from lung cancer. Two men, age 61 and 76 years, with lung cancers were referred for evaluation of a tumour on the tip of the nose. The third patient, a 57-year-old man, had developed a rosacea-like tumour on the tip of the nose; although he had no history of internal cancer, whole-body positron-emission tomography-computed tomography revealed a primary lung cancer. Skin biopsies of all 3 cases showed metastatic squamous cell carcinoma, and all primary lung cancers were squamous cell carcinomas. Only 3 patients are described here, and further reports are needed to substantiate this interesting phenomenon. When an elderly patient presents to dermatology with a tumour on the nose with or without known internal cancer, it is necessary to approach the diagnosis with caution.
Abstract. The Amazon shelf-break is a key region of the ocean where strong internal tides (ITs) are generated, which may have a key role to play on both Climate and Ecosystem, via its vertical mixing. AMAZOMIX survey (2021) collected microstructure and hydrographic (ADCP/CTD-O2) profiles to quantify mixing, associated processes and their impact on marine ecosystems. Measurements are obtained over M2 tidal period (12 h) inside and outside of both the ITs generation sites and propagation beams, respectively at mode-1 distances (90 km and 210 km) from the shelf-break to evaluate the IT impact on mixing. Hydrography analysis showed strong step-like characteristics (~20–40 m thick) and vertical displacements (20–60 m) triggered by ITs, as well as the signatures of high modes up to 5–6 on generation sites and IT pathways. The results of the microstructure analysis coupled with those of the hydrography revealed important mixing associated with a competition of processes between the semidiurnal shear of ITs and the baroclinic shear of the mean current (BC). Closer to the generation sites, mixing is stronger within [10-6,10-4] W.kg-1, with a greater contribution (~65 %) from ITs shear than BC shear. It is reduced but nevertheless considerable between [10-8, 10-6] W.kg-1 along the IT pathways, owing to equal contributions from ITs and BC shear. At a distance of ~225 km, mixing was still higher within [10-7,10-6] W.kg-1 because of the increased contribution (~65 %) of ITs shear, where IT beams may intersect and interact with background circulation. Mixing in no-tidal fields was fairly minimal ([10-8,10-7] W.kg-1), owing to a minor contribution (~50.4 %) of BC shear from the North Brazil Current. Finally, the nutrient flux estimations showed that ITs mixing could reach the surface (by a large tidal diffusivity of [10-4,10-1] m-2.s-1). This resulted in high vertical fluxes of nitrate ([10-2, 10-0] mmol N m-2.s-1) and phosphate ([10-3, 10-1] mmol P m-2.s-1), which can stimulate chlorophyll production, biodiversity and cool surface water, so influencing the whole ecosystem and climate in this river-ocean continuum region. This study provides a guide for the mixing parameterization in future numerical simulation (e.g., in physical-biogeochemical coupled models) in the Amazon region in order to include the impact of the IT turbulence on the whole ecosystem (i.e., from physics to biological production).
To identify common findings visualized on CT following damage control laparotomy, including post-surgical changes and additional injuries, and to determine change in frequency of post-laparotomy CT at our institution over time.Single institution, IRB-Exempt, retrospective review of the University of Kentucky trauma registry from 1/2006 to 2/2019 for all trauma patients undergoing exploratory laparotomy initially and subsequently undergoing CT of the abdomen and pelvis within 24 hours. Operative findings from surgical operation notes and findings reported on post-laparotomy CT were recorded, including vascular and solid organ injuries, operative changes, free intraperitoneal fluid/air, and retroperitoneal findings. Next steps in management were also recorded.In total 1,047 patients underwent exploratory laparotomy initially at our institution between 1/2006-2/2019. Of those, only 96 had a diagnostic CT of the abdomen and pelvis within 24 h after initial surgery, first occurring in 2010. Among these 96, there were 71 blunt and 25 penetrating injuries. Most common injuries recognized during exploratory laparotomy were bowel/mesentery (55), spleen (34), and liver (26). Regarding CT findings, all patients (96/96, 100%) had residual pneumoperitoneum, 84/96 (87.5%) had residual hemoperitoneum, 36/96 (37.5%) noted post-surgical changes or additional injuries to the spleen, 36/96 (37.5%) to the bowel/mesentery, and 32/96 (33.3%) to the liver, and 34/96 (35.4%) were noted to have pelvic fractures. After CT, 31/96 (32.3%) went back to the OR for relook laparotomy and additional surgical intervention and 7/96 (7.3%) went to IR for embolization. Most common procedures during relaparotomy involved the bowel (8) and solid organs (6).CT examination within 24 h post damage control laparotomy was exceedingly rare at our institution prior to 2012 but has steadily increased. Frequency now averages 20.5% yearly. Damage control laparotomy is an uncommon clinical scenario; however, knowledge of frequent injuries and common post-operative changes will aid in radiologist detection of additional injuries helping shape next step management and provide adequate therapy.
