American journal of surgery
-
Comparative Study Clinical Trial
Short-stay carotid endarterectomy is safe and cost-effective.
Carotid endarterectomy (CEA) is conventionally performed following a contrast arteriogram, under general anesthesia, and with postoperative admission to an intensive care unit (ICU). We investigated whether any of these traditional adjuncts to CEA is necessary. ⋯ This pilot study suggests that CEA can be safely performed without routine preoperative carotid arteriography; that routine ICU admission is unnecessary for the majority of cases; and that elimination of routine arteriography and ICU admission can reduce hospital charges for CEA by nearly one half.
-
The purpose of this study was to identify factors associated with unfavorable outcome following stab wounds to the heart in order to improve selection of patients who may benefit from aggressive resuscitative efforts. ⋯ We recommend that all patients suspected of having cardiac stab wounds be fully resuscitated and undergo thoracotomy, as significant survival can be achieved and death is not always the outcome.
-
The frequency and causes of gastrointestinal complications following esophagectomy for malignancy are unknown. ⋯ Surgical techniques aimed at improving gastric emptying following esophagectomy for cancer should improve operative morbidity and mortality.
-
Clinical Trial
Extracorporeal cardiopulmonary life support with heparin-bonded circuitry in the resuscitation of massively injured trauma patients.
Patients who have massive but potentially survivable injuries frequently die from complications of hypovolemia, hypoxemia, hypothermia, metabolic acidosis, and coagulopathy. Emergency cardiopulmonary bypass has been unsuccessful in preventing such deaths because it involves systemic anticoagulation that exacerbates coagulopathy. ⋯ ECLS with heparin-bonded circuitry offers supplemental capability in the resuscitation and cardiopulmonary support of selected massively injured patients while their primary injuries are being evaluated and treated.