The American surgeon
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The American surgeon · Sep 1995
Randomized Controlled Trial Clinical TrialThe influence of anesthetic method on infrainguinal bypass graft patency: a closer look.
Although several studies have demonstrated a reduced incidence of postoperative deep venous thrombosis among patients who receive regional anesthesia, the influence of anesthetic method on early arterial bypass graft patency has not been well studied. The records of 78 consecutive patients undergoing elective femoro-popliteal (FP) or femoro-tibial (FT) bypass grafts, and who were randomized to receive general anesthesia and postoperative patient-controlled intravenous narcotic analgesia (GEN, n = 41), or epidural anesthesia and postoperative continuous epidural analgesia (EPI, n = 37), were retrospectively reviewed. The two groups were evenly matched with respect to demographic characteristics, risk factors, and vascular variables. ⋯ Graft occlusion occurred in 11 (17.1%) of the 64 limb salvage cases, including nine (27.3%) GEN and two (6.5%) EPI cases (P < 0.05), and in seven (12.7%) of 55 greater saphenous vein grafts, including six (22.2%) GEN and 1 (3.6%) EPI cases (P < 0.05). By multivariate analysis, FT grafts, preoperative plasminogen activator inhibitor-1 (PAI-1) levels, and GEN were predictive of early graft occlusion (P < 0.05). Furthermore, the levels of circulating PAI-1 were higher 24 hours postoperatively among patients in the GEN group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Sep 1995
Clinical TrialLimiting cardiac evaluation in patients with suspected myocardial contusion.
A great deal of time and effort is spent attempting to diagnose myocardial contusion in patients with blunt thoracic trauma. Many diagnostic protocols have been proposed in the past. However, there is no test with sufficient specificity to predict which patients will develop complications that will require therapy. ⋯ These patients were simply admitted for 24 hours of continuous cardiac monitoring. No patient developed any complications of myocardial contusion requiring therapy. We conclude that it is safe to limit the cardiac evaluation in this group of patients.
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The American surgeon · Sep 1995
Case ReportsCentral venous catheterization via persistent left superior vena cava.
We describe the problems of clinical assessment of subclavian catheter placement whose course was noted to be along the left lateral border of the heart, suggesting malposition. After the catheter's position in a persistent left superior vena cava was confirmed by blood gas analysis, lateral chest X-ray film, and venography, the catheter was used to provide total parenteral nutrition without complications. The evaluation and workup of seeming malposition of central venous catheters and the embryologic development of a left-sided vena cava are discussed.