Surgery today
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There is evidence that blood transfusion is associated with an increased rate of tumor recurrence. This study was conducted to assess the survival advantage of giving autologous blood instead of allogeneic blood during surgery for esophageal cancer. ⋯ Autologous blood transfusion appears to be an independent prognostic factor for the survival of patients with esophageal cancer.
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A 63-year old woman underwent a resection of a pseudoaneurysm in the dorsalis pedis artery. The aneurysm was suggested to have formed because of a bruise on the dorsal aspect of the foot 5 years previously. This is a rare case of a traumatic aneurysm in the peripheral artery.
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A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. ⋯ A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.
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Over the past 20 years, it has gradually become apparent that the results of prolonged and extensive surgical procedures performed on critically injured patients are often poor, even in experienced hands. The triad of hypothermia, coagulopathy, and metabolic acidosis effectively marks the limit of the patient's ability to cope with the physiological consequences of injury, and crossing this limit will frustrate even the most technically successful repair. These observations have led to the development of a new surgical strategy that sacrifices the completeness of immediate repair in order to adequately address the combined physiological impact of trauma and surgery. ⋯ The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, the intra-abdominal packing is removed and definitive repair of abdominal injuries is performed. The "damage control" concept has been shown to increase overall survival and is likely to modify the management of the critically injured patient.
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A primary abdominal aortic dissection is exceedingly rare, especially in the absence of blunt abdominal trauma. We herein report a case of aortic dissection with aneurysmal dilatation (dissecting aneurysm) of the infrarenal abdominal aorta in a 61-year-old female patient, and discuss the diagnostic and therapeutic management of this rare disorder.