American journal of surgery
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Comparative Study
Avoidance of artifacts on computerized tomograms by selection of appropriate surgical clips.
Surgical clips (metallic or plastic) are frequently used for hemostasis and tumor marking. This study evaluated the radiographic and computerized tomographic appearance of different clips and their relative interference with computerized tomographic scans. Metallic clips (stainless steel, tantalum, and titanium) can all be seen on plain radiographs. ⋯ Recent studies have suggested that there may be some risk of torsion of stainless steel clips in nuclear magnetic resonance scanners resulting in tissue damage. Absorbable plastic clips cannot be seen on plain film but are visualized on computerized tomographic scans and do not appear to cause scan artifact. Overall, we recommend the use of either titanium hemostatic clips when tumor marking on plain film is required or plastic clips when tumor marking is less important.
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Case Reports
Noncardiogenic pulmonary edema after cardiopulmonary bypass. An anaphylactic reaction to fresh frozen plasma.
Nine episodes of fulminant noncardiogenic pulmonary edema after cardiopulmonary bypass were observed in eight patients between September 1977 and December 1982. All these catastrophic reactions occurred during administration of fresh frozen plasma 30 minutes to 6 hours after discontinuation of cardiopulmonary bypass. In one patient, two episodes of noncardiogenic pulmonary edema occurred 4 hours apart. ⋯ The last two patients in the series showed a steady and remarkable improvement in cardiac output when the wedge pressure was increased to a level above 15 mm Hg with the administration of normal saline solution. Our data suggest the following: (1) noncardiogenic pulmonary edema after cardiopulmonary bypass is most probably an anaphylactic reaction to fresh frozen plasma. (2) The syndrome is reversible within hours; in only one patient (who suffered noncardiogenic pulmonary edema twice) did adult respiratory distress syndrome develop. (3) The three deaths were not related to hypoxia but to the deleterious effects of low cardiac output associated with hypovolemia secondary to fluid loss through the lungs and possibly across other capillary beds. Therefore, treatment should include restoration of adequate left-sided filling pressures to achieve satisfactory cardiac output.
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A review of the surgical management of 21 patients presenting fractures, dislocations of the knee-joint associated with arterial injury, or both has been presented herein.
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Randomized Controlled Trial Comparative Study Clinical Trial
Diuresis with continuous infusion of furosemide after cardiac surgery.
We prospectively evaluated the diuretic effect of furosemide administered by bolus injection and by continuous infusion in 18 cardiac surgery patients. Nine patients were randomly assigned to receive 0.3 mg/kg of furosemide as a bolus injection at time 0 and again 6 hours later (nine patients) or 0.05 mg/kg per hour of furosemide as a constant infusion for 12 hours (nine patients). ⋯ Diuresis during continuous infusion of furosemide was less variable from hour to hour than after bolus injection of furosemide and was sustained throughout the infusion period. Although the continuous infusion of furosemide will not provide the rapid and vigorous diuresis that is necessary in some clinical situations, it may be useful whenever a gentle, sustained diuresis is desired.
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Computerized tomography has proved useful in the evaluation of selected patients suffering blunt abdominal trauma. Seventeen patients with major multisystem injuries were treated using a protocol involving abdominal computerized tomographic scans for evaluation of intraabdominal injury. ⋯ The remainder of the patients with intraabdominal solid organ injury diagnosed by computerized tomographic scan were followed under strict guidelines and recovered without surgery. Computerized tomography represents a quick, accurate diagnostic technique for dealing with blunt abdominal trauma in selected multiply injured patients.