American journal of surgery
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Infectious complications currently account for 80 percent of deaths from acute pancreatitis. The adjunctive role of antibiotics in the prevention and treatment of secondary pancreatic infections has received insufficient attention. ⋯ Until such studies are available, if antibiotics are to be used, their choice must be based upon indirect criteria: the ability of the antibiotic to effectively penetrate pancreatic tissue and juice, knowledge of the most common pancreatic pathogens, and the ability of the antibiotic to exceed the in vitro concentration (MIC-90) in pancreatic juice for the common pathogens. Recognition of the limited state of knowledge regarding antibiotics in acute pancreatitis may stimulate future investigations.
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Over a 3-year period, 519 patients underwent laparotomy for liver injuries. Nine (2 percent) required insertion of an atrial caval catheter to control hemorrhage from perihepatic venous injuries. In three cases, the shunt arrested the hemorrhage, allowing successful surgical repair of the venous injuries. From a careful analysis of our experience, we have identified common errors made in shunt placement, developed a modified atrial caval catheter, and have simplified the surgical technique for insertion.