European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes
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Hypertonic/hyperoncotic solutions (e.g. HHS: 7.2% NaCl/10% dextran-60) are highly effective to normalize cardiovascular function in hemorrhagic shock due to rapid mobilization of fluid from the extravascular compartment. Since experiences are limited with regard to potential side effects of this treatment on the central nervous system, the present studies were carried out under particular consideration of the cerebral blood flow and O2 supply. ⋯ Hemorrhagic hypovolemia which led to a left shift of the cerebral PO2 histogram was followed by gradual normalization after fluid resuscitation. The current findings taken together do not indicate adverse side effects of this efficient method of fluid resuscitation with regard to the cerebral blood and O2 supply. The results make worthwhile further investigations on HHS in the presence of a focal brain lesion causing brain edema to find out whether the HHS are useful also for the treatment of intracranial hypertension.
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Twenty sheep were placed under general anesthesia and five ribs (6-10) were transected at their lateral angle using a pair of rib shears. The fractures were stabilized by titanium wire mesh plates. ⋯ The study showed that the osteosynthesis stabilized the fractures and that the healing is similar to untreated rib fractures. This osteosynthesis method is a good contribution to severe injured chest treatment.
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Randomized Controlled Trial Clinical Trial
Transcutaneous electrical nerve stimulation for pain relief following inguinal hernia repair: a controlled trial.
The efficacy of transcutaneous electrical nerve stimulation (TENS) in relieving postoperative pain has been assessed by means of a prospective randomized controlled trial in 62 male patients undergoing unilateral inguinal herniorrhaphy. Thirty-four patients received TENS and 28 patients received sham TENS for 48 h after the operation. ⋯ We were unable to detect any significant differences in these variables when the two groups were compared. These results do not support the use of TENS.
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A controversy still exists on whether the liver changes to a lactate producer during hemorrhagic shock. Considerable disagreement has been reported on the question whether crystalloids or colloids should be used when treating hemorrhagic shock. ⋯ The liver did not seem to produce lactate at any stage of the shock level, but during early retransfusion it changed transiently to a lactate producer. Later during the resuscitation period, the correction of arterial hypotension seemed to be unstable and the correction of acidosis incomplete after crystalloid infusion compared to transfusion or colloid substitution.
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Patients who received aortic disc valves during cardiopulmonary bypass (CPB) with extreme hemodilution, obtained with preoperative blood withdrawal, infusion of acetate solution and use of blood-free priming fluid, bled less than patients operated with moderate dilution. One hour after CPB with extreme dilution when the autologous blood had been reinfused, platelet adhesiveness was twice as high as in the moderate dilution group. ⋯ Later, thrombocytosis with hyperreactive platelets and hyperfibrinogenemia developed in all patients. This might predispose for thrombosis.