American journal of surgery
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Historical Article
Designation or dedication: seven men in the evolution of a trauma center.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy with and without drainage. A randomized, prospective study of 300 patients.
A randomized, prospective study of 300 cholecystectomies was undertaken to evaluate the merits of drainage through a standard Penrose or Chaffin-Pratt sump tube matched against no drainage at all. There was no difference in mortality or length of hospital stay. ⋯ Neither drain fulfilled its objective of providing outflow for a subhepatic collection, thus avoiding bile peritonitis. This study suggests that surgical drainage after every uncomplicated cholecystectomy is unnecessary and unwise.
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Fifty-nine intubated nonhypoxic patients with clinical criteria associated with adult respiratory distress syndrome were studied. Clinical measurement were sought to identify patients before severe hypoxemia occurred. Etiologic factors, chest roentgenography, effective static compliance, intrapulmonary shunt and arterial blood gases on 40 and 100 percent inspired oxygen were analyzed. ⋯ When either determination was above these levels, the probability of pulmonary deterioration was 10 percent. The use of sequential arterial blood gases allows the selection of high risk patients for adult respiratory distress syndrome. This ensures that therapy is offered at the most beneficial time.
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Multiple extremity gangrene developed in five patients as a complication of dopamine therapy. The clinical conditions were (1) penetrating chest trauma requiring pneumonectomy with postoperative sepsis, (2) cardiac arrest with aspiration pneumonia, (3) lymphoma with sepsis, (4) Klebsiella pneumonia, and (5) myocardial infarction. The development of acrocyanosis leading to gangrene occurred at dopamine dosages of 5.1 to 10.2 micrograms/kg/min. ⋯ Treatment of tissue ischemia related to dopamine depends on early recognition of acrocyanosis. Phentolamine, an alpha blocker, has been recommended for treating dopamine ischemia, either through local instillation into ischemic tissues or intravenous infusion. We recommend a high index of suspicion for, and early treatment of, underlying consumptive coagulopathy in all patients requiring dopamine.
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Over 500 fine (no. 22) needle aspiration biopsies were done on head and neck lesions. The total accuracy for the series was 94.5 percent. ⋯ Only lymphomatous lesions gave a lower accuracy rate: 75 percent. This method of evaluating masses in the head and neck is simple, rapid, inexpensive, well-tolerated and harmless, and is very accurate when there is close cooperation between the clinician and the cytopathologist.