American journal of surgery
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We conclude that (1) the activated clotting time (ACT) is an accurate method of monitoring anti-coagulation during peripheral vascular surgery and can easily be performed by a technician in the operating room or at the bedside; (2) an initial heparinizing dose of 120 to 130 units/kg is adequate in 95 per cent of the patients; (3) the ACT should be maintained at greater than twice the control values (180 to 200 seconds), which required supplementation within 2 hours in 21 per cent; (4) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption; (5) the patient's heparin dose-response curve should be used to calculate the amount of supplemental heparin needed to maintain the ACT at a safe level; (6) protamine should be given if the ACT at the conclusion of the operation is greater than 150 seconds (50 per cent of our patients); and (7) a final ACT 15 to 30 minutes postoperatively should be obtained to ensure adequate reversal or to detect heparin rebound or depletion of clotting factors.
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The use of meshed skin grafts allows an evaluation of the biologic properties of stored tissues such as skin. Frozen allograft may serve as an excellent biologic membrane, but it is not a satisfactory product for longer term allografting (intermediate allografting). The method of thawing (microwave oven versus water bath) appeared to have little effect on the ultimate viability and outcome of the frozen allograft.
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Two hundred twenty-five cases of acute hepatic trauma were reviewed. Thirty-four patients died, 28 (82 per cent) as a direct result of exsanguination. The successful management of hemorrhage associated with severe liver injuries requires early diagnosis, prompt hemostasis and restoration of blood volume, close attention to coagulation factors, and the precise application of surgical techniques.
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A selected group of men whose eponyms are currently used in biliary tract surgery are described. The eponyms chosen comprise two areas: gross anatomy (Glisson, Wirsung, Santorini, Winslow, Heister, and Vater) and operative anatomy (Kocher, Courvoisier, Morison, Hartmann, Calot, Roux, and Oddi). A brief review of biliary tract disease from antiquity until the 17th century places these men in proper historical sequence. A condensed biographical sketch of each man's life and work is provided and a few closing comments are made about eponyms.