American journal of surgery
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Comparative Study
Plasma supplementation is beneficial for coagulation during severe hemorrhagic shock.
Hemorrhagic shock (HS) often causes coagulopathy due, in part, to decreased coagulation proteins. This study assessed the efficacy of fresh frozen plasma (FFP) in preventing this coagulopathy following a canine model of HS designed to mimic bleeding with shock as seen in the emergency department followed by bleeding without shock as seen during operation for control of bleeding. ⋯ Severe HS beyond one blood volume exceeds the interstitial stores of coagulation protein, thus necessitating FFP supplementation.
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We describe our experience with a supraumbilical skin-fold incision for pyloromyotomy in infants. Our technique uses a vertical fascial incision. This approach provides excellent exposure to the pylorus, allows greater operative flexibility, and results in a superior cosmetic outcome compared to the traditional right upper-quadrant incision.
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Comparative Study
Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis.
One of the theoretic advantages of using a stapled versus handsewn ileal pouch anal anastomosis (IPAA) in restorative proctocolectomy is a reduction in septic complications. We performed this study to compare the incidence of early septic complications in patients undergoing restorative proctocolectomy with stapled or handsewn IPAA. ⋯ The stapled technique for IPAA has fewer septic complications and results in fewer sepsis-related pouch excisions, in our hands, than the handsewn technique technique, for treating patients with ulcerative colitis.
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Occasionally, ipsilateral ischemia develops following the groin insertion of an intra-aortic balloon catheter. Various treatment options have evolved, and include replacing the catheter in the opposite groin, removing it completely, or performing a femorofemoral bypass to deliver blood flow below the catheter. Outlined in this paper is a simple method to restore blood flow to a threatened limb, during femoral artery exploration, in the presence of an intra-aortic balloon. This method is also appropriate for optimal positioning of the balloon catheter prior to femorofemoral bypass.
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Since the initial description of the radial arteriovenous (AV) shunt, hemodialysis has played a primary role in the survival of patients with chronic renal failure. However, it is not unusual to be confronted with patients on chronic hemodialysis who have exhausted all superficial venous access sites. ⋯ We have performed this technique with good success in 12 patients. Further experience and longer follow-up are needed.