The American surgeon
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The American surgeon · Jul 1996
Case ReportsHepatic and vena cava resection using cardiopulmonary bypass with hypothermic circulatory arrest.
When large hepatic or retroperitoneal tumors encroach upon hepatic veins or vena cava and make conventional resection hazardous, the most commonly used method of hepatic resection or vena cava reconstruction includes hepatic vascular exclusion, at times with venovenous bypass or aortic occlusion. These techniques result in warm liver ischemia, and may be accompanied by significant systemic hypotension, despite aggressive central venous preloading. Hepatic lobe (two patients) and retroperitoneal sarcoma (one patient) resections were done in a cold, bloodless field without significant complications. ⋯ Systemic circulatory arrest was done at 15 degrees C with isolated retrograde perfusion of the brain through the jugular veins. Hepatic vein and vena cava reconstructions were performed with arrest times of between 30 and 78 minutes. Blood loss was gradual and easily controlled, occurring during the rewarming phase when clot formation was inhibited by cold and heparin.
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The American surgeon · Jul 1996
Penetrating chest trauma: should indications for emergency room thoracotomy be limited?
A total of 160 patients underwent emergency room thoracotomy (ERT) from January 1988 to June 1995. There were 142 male and 18 female patients with ages ranging from 15 months to 72 years old with a mean age of 31 years. Blunt trauma was the mechanism of injury in 11 patients; none of them survived, and they were excluded from further analysis. ⋯ Of the four survivors, three were in Scene Class III and one was in Scene Class IV. This study confirms a previous report that, overall, ERT has a very low survival rate. ERT should be abandoned in patients sustaining blunt trauma, and should probably be limited to patients sustaining penetrating chest injuries who fall into the physiologic Classes III or IV at the scene.