American journal of surgery
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Although the preservation of splenic tissue may prevent overwhelming infection after splenectomy, the degree of protection conferred by small remnants has not been optimal. We investigated whether either splenic reticuloendothelial clearance of a blood flow-dependent colloid or macrophage and T-cell populations might be altered by resection or autotransplantation of the spleen. ⋯ Such clearance is dependent on spleen weight and is not related to differences in either macrophage or helper or suppressor T-cell populations. This suggests that autotransplantation of the spleen is inferior to preservation of even a small hilar remnant and implies that repair or partial resection of the spleen will provide greater protection than autotransplantation.
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This study has reviewed the results of burn care in a burn center between 1978 and 1986. The total population included 1,458 patients. Mean burn size was 19 percent total body surface area, mean patient age was 24.4 years, and overall survival rate was 92 percent. ⋯ Since that, the survival rate increased to 77 percent and mean length of hospital stay increased to 35.2 days. The early burn mortality rate remained nearly constant during the period of study (17 percent during the first half of the study and 16 percent during the second half), but the late mortality rate decreased significantly during the second half of the study (24 percent versus 8 percent, p less than 0.01). These data demonstrate increased survival rates after major thermal injury due to improvements in prevention and treatment of sepsis and other late complications of thermal injury.
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Comparative Study
Beneficial effects of a hypertonic solution for resuscitation in the presence of acute hemorrhage.
Crystalloid solutions such as Ringer's lactate have become the standard for initial volume replacement after hemorrhage. Although the relative merits of blood, colloid, and crystalloid have been extensively studied, little attention has been directed toward determining the optimal composition of the crystalloid solution. Based on the beneficial properties of hypertonic lactated saline solution in burn resuscitation, we have extended its use to acute hemorrhage. ⋯ The hypertonic lactated saline solution group required less fluid to restore and maintain cardiac output and blood pressure while maintaining better urine output. Although the Ringer's lactate solution group had increased shunt function indicative of pulmonary dysfunction, the shunt function in the hypertonic lactated saline solution group did not differ from that in the control group. Serum sodium and osmolality values were higher in the hypertonic lactated saline solution group, but at no time did they approach toxic levels.
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Comparative Study
Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet.
Systems that objectively score severity of illness and intensity of patient care interventions have been used to guide the appropriate use of intensive care facilities, provide information on nurse staffing ratios, validate subjective classifications of patient illness, and normalize scientific and financial studies for severity of illness. Existing scoring systems require a well-trained observer to perform a thorough chart review to complete manual scoring forms. ⋯ In prospective studies, these computerized scores correlated well with manual TISS scores, intensive care unit mortality, intensive care unit length of stay, hospital length of stay, and a subjective classification of patients to graded levels of hospital care. Such automated scores may be used for real-time allocation of health care resources and normalization of prospective studies for severity of illness.
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Between February 1973 and December 1986, 4,787 patients underwent open heart surgery at Samuel Merritt Hospital. Retrospective analysis revealed 395 (8 percent) consecutive patients who required hemodynamic support with the intraaortic balloon pump. Thirty percent of the patients had preoperative placement, 56 percent needed the balloon in order to wean from cardiopulmonary bypass, and 14 percent required placement in the postoperative period. ⋯ This allows easier access for intraaortic balloon pump placement in hypotensive patients. The presence of a clinical history of peripheral vascular disease was also a highly significant risk factor for vascular complications. Other risk factors increasing the likelihood of vascular compromise included catheter size and duration of counterpulsation.