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Wed Sep 12 22:23:12 BST 2007

Ron - 

That's an important point.  IAH vs. ACS.  

Thanks. 

BTW, I'm not sitting on any knowledge.  Ask my wife, she will tell you!!!

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

Everyone deserves to make an informed decision
                                - Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ronald Gross
Sent: Wednesday, September 12, 2007 3:52 AM
To: trauma-list at trauma.org
Subject: Re: Open Abd

Errington,

I have to admit that I do not know the answer to your questions about vacs
and fistulae, but when I get outta the ED I will start to look up the
literature - as I am sure you have already done, and arre holding that
knowledge for future discussion...  ;-)

As to the abdominal pressure of 30, I am going to suggest that with a
patietn who has (1) no respiratory compromise, (2) a normal BP, and (3)
normal urine output, the patietn may have IAH (intraabdominal hypertension)
but NOT ACS (abdominal compartment syndrome).

Ron

>>> "Errington Thompson" <errington at erringtonthompson.com> 09/11/07 6:15 PM
>>>
We had a recent discussion about open abdomens in our M&M.  There some
things thrown around as facts and I'm not sure that they are really facts.
So, I thought I would ask.  

1.	If you have an intra-abdominal pressure of 30, can you schedule the
patient to go to the OR in a couple of hours or is this hair on fire
emergency?  (The patient is normotensive and still making urine.)

2.	Once you open the abdomen and place a wound vac, does the amount of
suction on the wound vac relate to fistula rate?

3.	Once you have a fistula, does the suction of the wound vac prevent
healing?

4.	What are the tangible things that we can do once we open an abdomen,
and we know we have to leave the abdomen open, that can decrease fistula
rates?

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Mission Hospital
Asheville, NC
Author - A Letter to America
www.whereistheoutrage.net

Everyone deserves to make an informed decision
                                - Errington Thompson, MD

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Tuesday, September 11, 2007 2:45 PM
To: Trauma & Critical Care mailing list
Subject: RE: Remember.....

Your sentiments are widely shared and much appreciated.  Pity those
memories have so little to show for them.  Who could have imagined how
thoroughly we have failed our dead?  It's worse than forgetting.  Shame
on us all.
Here's hoping that some anniversary hence will commemorate more than the
day the world sank into fear and despair.

Pret Bjorn
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross
Sent: Tuesday, September 11, 2007 10:34 AM
To: SURGINET: General Surgery Discussion List; Trauma List
Subject: Remember.....

Dear Colleagues,

As I woke up this morning, I remembered back six years and realized that
on that day at this time our world changed forever.  Many of us lost
friends and family, and we all watched in horror and disbelief as the
carnage unfolded.  Had I not spend 2 days on "the Pile" with the
Fairfield Fire Department the second day after the Towers fell, I would
have never been able to comprehend the magnitude of New York, the
Pentagon, and Pennsylvania.  The smells still are like they were then,
the visions will never leave my eyes - and the tears for all who were
lost and for all who have survived have not dried.

I ask that we all look around us at the world that we live in and
realize that the carnage continues.  Let us all remember the past, and
work together to make the future better for our children and their
children.  

Please join me and remember this day six years ago.  Pray for the
innocent lives that were taken, and for the ones left behind to pick up
the pieces of a senseless act of cowardess cloaked in fanaticism.

Best wishes to all,
Ron

>>> David Dent <dmdent2 at MWEB.CO.ZA> 9/11/2007 7:56 AM >>>
Danny

My strategy 1 was to cut.
My strategy 2 is not to cut. An extremely senior American surgeon
decided to
treat a bleeding antral carcinoma in a nonagenerian by chronic
transfusion.
The patient held out for nearly a year, and attended an international
meeting in Brussels.

The surgeon was Jonathan Rhodes, and the patient was himself.

So, yes, there is still a bifurcation in the path of decision. You and
your
patient must decide.

David

----- Original Message -----
From: "Ronald Gross" <Rgross at HARTHOSP.ORG>
To: <SURGINET at LISTSERV.UTORONTO.CA>
Sent: Tuesday, September 11, 2007 12:44 PM
Subject: Re: OK, kill me...

> Danny,
>
> I say go for it.  Being 90 and active is a great thing - and this guy
is
> probably far more active than half of my fellow 56 year olds who spend
> their lives on the couch - and who we wouldn't give a second thought
to
> operating on!
> My Dad used to tell me that  "You are only as young as you think you
> are".....
>
> Ron
>
>>>> Danny Rosin <drosin at MAC.COM> 9/10/2007 6:07 PM >>>
> 90 YO, active, with a bleeding antral tumor, scheduled for lap distal
> gastrectomy tomorrow.
> What say ye?
>
> Danny Rosin, Israel.

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