Graphically thrilling, medically, scientifically and technologically relevant – we stand at the threshold of a most progressive concept in sharing medical information. On behalf of the staff and editors, welcome to the premiere issue of the Journal of Surgical Radiology. With its multidisciplinary philosophy and advanced connectivity we are venturing into uncharted territory, exploring a “new world” of education heeding the call of both factual information and a visceral impression of how best to respond to the ever changing environment in which we learn and practice in our fields.
July 2010
Editorial: July 2010
Original Article: Extrathoracic Lung Herniation from Blunt Trauma: A Review
Introduction The Organ Injury Scale for chest wall trauma, last updated in 1992, governs the diagnosis and management of nearly half of all trauma patients. When this scale is used in association with the abbreviated injury score (AIS) and the trauma injury severity score (TRISS), overall survival following trauma can be estimated. There is presently no standardized scoring system for blunt chest wall trauma in the setting of lung herniation.
Methods A systematic review of the literature on blunt chest wall trauma was completed and all reports of lung hernias since 1500 compiled. Four hundred cases of blunt trauma to the chest leading to lung herniation were identified and used to develop a classification scheme for extrathoracic lung herniation, adapt the organ injury scale for chest wall trauma to include extrathoracic lung hernias, and elucidate a treatment algorithm based on the type of lung hernia.
Results Lung hernias can be divided into anterior and posterior; anterior hernias can be further divided into intercostal and parasternal. Intercostal hernias should be managed acutely by way of anterior chest wall exposure and potential thoracotomy due to the significantly higher risk of incarceration and/or strangulation.
Discussion Anterior lung hernias should be grade III (AIS 3), parasternal lung hernias as grade IV (AIS 4), posterior lung hernias or the presence of any incarcerated lung as grade V (AIS 4), and strangulated lung hernias as grade VI (AIS 5). Incarcerated or strangulated lung has a high reported morbidity and mortality.
 Extrathoracic Lung Herniation from Blunt Trauma: A Review | 7219 Kb |
Column: Why MDs Dread EMRs
How do we know doctors hate EMRs (electronic medical records)? Look at anemic adoption rates. Big clinics and large physicians’ groups lead the way in buying them, but the most optimistic statistics say that fewer than 50% of even large groups have EMRs. Overall, perhaps 20% of physicians have EMR, but for small groups the best guess is 5%. And, when such features as e-prescribing, e-visit, and PHR (patient-held record) integration are considered, it is likely that less than half of physicians use their EMR for little more than their own templates and a few favorite features.
| Why MDs Dread EMRs | 429 Kb |
Original Article: Nonoperative Management of an Esophageal Perforation Following Combitube Placement
Introduction The Esophageal-Tracheal Combitube (ETC) is widely used for the management of the airway during cardiopulmonary resuscitation in the pre-hospital setting and is associated with a notable incidence of serious complications, including, though rarely, esophageal perforation. Esophageal perforation is a life-threatening condition associated with high morbidity and mortality rates. Traditionally, esophageal perforation was considered a surgical emergency. However, with the advent of broad spectrum antibiotics and less invasive operative interventions, nonoperative treatment of esophageal perforation has become more common.
Case Report A case of esophageal perforation due to ETC placement in a 38-year-old male is described here. The patient was involved in a high-speed motor vehicle collision and was intubated with a Combitube in the field prior to being airlifted to our level-1 trauma center. The Combitube was found to have perforated the esophagus on computed tomography (CT) scan. A CT esophagogram confirmed this finding with a contained perforation. The patient was managed with nonoperative treatment.
Discussion Esophageal perforation following ETC placement is a rare, but potentially fatal complication. If recognized early, a patient with a limited and/or contained perforation with minimal symptoms may be managed with nonoperative treatment.
| Nonoperative Management of an Esophageal Perforation Following Combitube Placeme | 2633 Kb |
Original Article: Massive Thromboembolism Captured By Real-Time Echocardiography
Thromboembolism is a potentially serious complication following any surgical procedure. Its incidence is particularly high after elective orthopedic procedures, such as a total knee arthroplasty. We present a patient who developed a massive thromboembolism captured by real-time echocardiography, who was undergoing ultrasound as part of an unrelated clinical study.
| Massive Thromboembolism Captured By Real-Time Echocardiography (PDF) | 522 Kb |
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