American journal of surgery
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A comparative study was made between 60 patients in whom drainage of subhepatic space was performed after uncomplicated cholecystectomy and 60 patients in whom no drainage was performed. In addition, 30 patients were treated without drainage, nasogastric suction, or intravenous fluids. After operation the patients were evaluated as to postoperative pyrexia, wound infection, lung atelectasis, thrombophlebitis, and postoperative stay in hospital. ⋯ Postoperative stay in hospital was shorter in the patients without drainage and shortest in those treated without drainage, nasogastric suction, and intravenous fluids. Nasogastric suction and intravenous fluids are not needed postoperatively, as the degree of the paralytic ileus is very slight and they may be harmful, causing lung atelectasis and thrombophlebitis. Uncomplicated cholecystectomy may be performed safely without drainage, postoperative nasogastric suction, and intravenous fluids.
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Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. ⋯ The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic appearance. This satisfactory outcome was realized with less than ten days lost from work.
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Comparative Study
The management of flail chest. A comparison of ventilatory and nonventilatory treatment.
Retrospective analysis of forty-two consecutive patients with flail chest injuries admitted to the Trauma Research Unit of the Naval Regional Medical Center, San Deigo from June 1972 to July 1975 compared ventilatory and nonventilatory management. The actual need for ventilatory support in these patients was determined by analyzing their records for evidence of significant pulmonary dysfunction. This allowed division of patients into three groups: "appropriately" ventilated; "inappropriately" ventilated; and nonventilated. ⋯ Treatment-associated complications were more frequent in the ventilated groups. Because of these findings, we belive that mechanical ventilation should be used in the treatment of flail chest injuries only for significant pulmonary dysfunction and not for the purpose of stabilizing the chest wall. If respiratory support is required, it should be discontinued when normal gas exchange has been restored.
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Retrospective analysis of twenty-eight patients with perforated gastric ulcers and 141 patients with perforated duodenal ulcer showed that delay in surgery increased operative mortality. Gastrectomy is advocated for gastric ulcers, and definitive ulcer surgery, not plication, for duodenal ulcers.
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Twenty-eight anemic control dogs were subjected to isolated cerebral hypoxemic (PO2,35+/-5 mm Hg) perfusion for 2 hours. All were found to have functional pulmonary impairment. Two hours later, twenty were sacrificed and found to have the bilateral anatomic complex of the respiratory distress syndrome (RDS). ⋯ These findings are offered as additional evidence that RDS has a centrineurogenic etiology. We postulate the following sequence: "shock" causes cerebral (probably hypothalamic) cellular oxygen deprivation and dysfunction; there is autonomically mediated, increased resistance of the pulmonary venules ("postcapillary sphincters"); this leads to capillary hypertension, congestion, hemorrhage, edema, surfactant inactivation, and atelectasis. Pulmonary denervation blocks this sequence and protects the lung.