American journal of surgery
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A retrospective review of 1,000 elective cholecystectomies was undertaken to identify factors associated with wound infection. The technic of wound drainage appears to influence the incidence of infectious wound complications to a significant degree.
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Three hundred fifty-seven groin hernia repairs were performed under local anesthesia using a long-lasting local anesthetic agent. An ilioinguinal, iliohypogastric, and twelfth intercostal nerve block was carried out initially, followed by regional infiltration of the agent, using a technic first described by Ponka [8] with several modifications. This technic can be employed suffessfully in the majority of groin hernia repairs. ⋯ We have observed a significant reduction in postoperative discomfort and the virtual elimination of urinary retention, urinary sepsis, atelectasis, and phlebitis in these cases. All patients are fully ambulatory, without assistance immediately after surgery and the majority are discharged the same day or the following morning. This results in a marked reduction in the total cost of repairing a groin hernia.
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The records of ninety-two patients treated between 1965 and 1976 at the Boston City Hospital for penetrating wounds of the heart were reviewed and the results were compared with a previous series of twenty-five patients admitted to the same institution between 1956 and 1964. The annual incidence rose from 2.8 cases during the first period to 8.0 during the more recent years. Gunshot wounds increased in frequency in the second period. ⋯ However, there were more complex wounds and agonal patients subjected to immediate emergency room thoracotomy during the second phase of this experience. The salvage rate in the latter group of patients gradually improved and averaged 24% between 1965 and 1976. These data indicate that an aggressive approach, including the use of immediate thoracotomy, to the agonal patient with a heart wound will be rewarded with salvage of some patients.
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Eight commercially available soft cuff endotracheal tubes were studied to determine the relationship between inflation pressure distention of the cuff. Although the balloon cuff may be easily distensible in open air, when confined within the trachea small increments in the inflation volume may produce high pressures. ⋯ Major tracheal complications in a busy ICU were examined before and after the introduction of a controlled pressure tube. Control of intratracheal cuff pressures decreased major tracheal complications tenfold and eliminated complications specifically related to the cuff.