American journal of surgery
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Opiates such as morphine have a direct spinal effect, acting at special receptor sites in the dorsal horn. When morphine is administered epidurally, it diffuses to the cord substance, producing analgesia of improved quality after a dose of 2 to 4 mg. ⋯ Significant side effects are uncommon, but pronounced respiratory depression can occur late and careful observation is necessary. The first instance of paraplegia in association with epidural morphine anesthesia has been reported herein.
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The predisposing anatomic alterations or features of thoracic outlet syndrome have been tallied to better define this difficult and inchoate issue. In the last 34 supraclavicular operations involving 33 patients (for a total operative experience of 128 procedures), we have found the anterior insertion of the middle scalene muscle to be present in 48 percent of our patients. ⋯ In addition, 10 percent of our patients had a middle scalene band intimately associated with the middle scalene muscle, often-times inseparable, for a 58 percent incidence of middle scalene involvement in the thoracic outlet syndrome. With data such as those presented herein, a more simplified operation than the heretofore popular all-out attack on the first rib may well be in the offering.
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Randomized Controlled Trial Clinical Trial
Shaving versus skin depilatory cream for preoperative skin preparation. A prospective study of wound infection rates.
A prospective, randomized study compared the effect of preoperative shaving versus chemical depilation on wound infection in 253 patients. No statistical difference was found between the two methods. Depilatory cream did save time by allowing hair to be removed the day before surgery and did offer an advantage in areas that were difficult to shave or if the patient was scheduled for diagnostic procedures and operations in the same operative area in close succession.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of synthetic adhesive moisture vapor permeable and fine mesh gauze dressings for split-thickness skin graft donor sites.
SAM and fine mesh gauze dressings were compared on 60 consecutive skin graft donor sites. SAM dressings are significantly better than fine mesh gauze dressings for healing of split-thickness skin graft donor sites; healing occurs much more rapidly with much less pain. In patients known to be colonized with Pseudomonas, care should be taken when using SAM dressings, although it is not an absolute contraindication. There were no clinically significant differences between Tegaderm and Op-Site.
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Over a 15 year period 120 patients with neck injuries that penetrated the platysma were studied. Appropriate treatment was initiated in the emergency room. Sixty-one patients underwent exploration and 59 were observed. ⋯ The majority were Zone II injuries. Our morbidity and mortality rates are slightly lower than those reported in most series. This review supports the concept that therapy for penetrating injuries to the neck should be individualized.