American journal of surgery
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A retrospective study of sixteen patients with pelvic fractures compounded through the perineum, rectum, or vagina showed a mortality of 50 per cent. The cause of death in seven of the eight patients was sepsis and multisystem failure. The initial surgical management of these patients must include complete diversion of the fecal stream so that pelvic and systemic sepsis may be prevented.
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Biography Historical Article
A critical study of Lister's work on antiseptic surgery.
The work of Pasteur on alcoholic and lactic acid fermentation demonstrated that minute organisms (germs) caused these fermentative changes. Lister applied these basic findings in the introduction of his antiseptic system. Its principles were based on the destruction of germs by antiseptics (carbolic acid) to prevent their entering the wound or spreading after surgery. ⋯ The believers of the germ theory defended Lister's theories whereas the nonbelievers of the germ theory created an atmosphere of resistance to Listerism. The work of Koch in 1878 on the etiology of traumatic infective diseases contributed greatly to the acceptance of Lister's antiseptic principles. By the mid 1880s there was a rapid increase in the use of antiseptic technics, soon followed by the introduction of aseptic methods and rapid progress in surgery.
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Aspiration has been suggested as a source of pulmonary complications seen in patients with tracheal intubation. A previous study demonstrated that the high incidence of aspiration in patients with tracheostomies can be decreased by modification of the tracheostomy tube cuff design. In the present protocol, 100 patients with endotracheal tubes in place were studied to document the incidence of aspiration and to attempt to decrease the incidence by modification of cuff design. ⋯ In 17 patients with modified standard cuffed tubes, the incidence of aspiration was decreased to 29% (5 patients). Aspiration was further decreased to 20% (7 patients) in the 35 patients with high volume, low pressure cuffed tubes. These results demonstrate that the incidence of aspiration in patients with endotracheal tubes can be decreased by modification of endotracheal tube cuff design.
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Three patients with profound hypothermia were treated by rewarming on partial bypass. Two surivived and have normal mental and metabolic functions. The resuscitation of the hypothermic patient should be approached with enthusiasm since the outcome is often much better than expected from initial vital signs and neurologic examination. ⋯ Certainly ventricular fibrillation is a compelling indication. Patients with frozen extremities might also benefit from this method since theoretically tissue salvage would be increased. Finally, those patients who do not respond rapidly to external rewarming may be at less risk of ventricular fibrillation if rewarmed on bypass.