American journal of surgery
-
Biography Historical Article
Problems and resolutions in the development of the flexible plastic blood container (Carl W. Walter).
-
Comparative Study Clinical Trial
Outpatient inguinal herniorrhaphy with both regional and local anesthesia.
Fifty-three patients who were undergoing outpatient inguinal herniorrhaphy with short-acting regional anesthetic agents and local infiltration of a long-acting anesthetic were retrospectively compared with a matched population of 53 hospitalized patients who were undergoing herniorrhaphy with a long-acting regional anesthetic. There was a significantly greater incidence of urinary retention in the hospitalized patients who received long-acting regional anesthetic agents. ⋯ This can result in significant savings in hospital bills. We suggest that anesthesia for inguinal herniorrhaphy is most satisfactorily provided by the combination of a short-acting regional anesthetic agent and a long-acting local one.
-
Case Reports
Method for intraoperative assessment of organ perfusion and viability using a miniature oxygen sensor.
A specially designed miniaturized Clark polarographic electrode was used to measure organ surface oxygen tension during surgical operations in 10 patients as a means of determining tissue perfusion and viability. When applied to organ surfaces, the sensor noninvasively provides real-time assessment of tissue PO2. ⋯ Tissue temperature is independently measured and may be used to assess the metabolic activity of the tissue monitored. Organ surface oximetry using the miniature PO2 sensor is a practical and repeatable method for the intraoperative assessment of organ perfusion and viability.
-
One hundred nine patients with the diagnosis of pulmonary contusion were studied retrospectively. Thirteen deaths were respiratory related (12 percent of patients). All of the patients were quickly resuscitated with crystalloid solutions as necessary to restore perfusion to normal. ⋯ When survivors and nonsurvivors were analyzed by group, both individually and collectively, no correlation was found between oxygenation and oncotic pressure. Survivors and nonsurvivors exhibited similar post-traumatic courses in the PaO2/FiO2 ratios with differences not becoming significant until the eleventh day after injury. We conclude that contusion is not a progressive lesion unless pneumonia supervenes and that pulmonary dysfunction after contusion is unrelated to hemodilution.
-
The diagnosis of blunt cardiac injury is often difficult to make because of the multiple associated injuries, the lack of specific physical findings, and the lack of sensitivity and specificity of the electrocardiograms and enzyme changes. The two-dimensional echocardiogram and the monitoring of filling pressures and cardiac indexes by pulmonary artery catheterization have an advantage over the electrocardiogram, CPK isoenzymes and technetium pyrophosphate scans because both anatomic and functional data are obtained, data are rapidly available, and the tests can be used repeatedly at the bedside.