The American surgeon
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The American surgeon · Nov 1998
Case ReportsSuccessful outcome in Swan-Ganz catheter-induced rupture of pulmonary artery.
Swan-Ganz catheter-induced pulmonary artery (PA) rupture is rare, with an incidence of 0.016 to 0.2 per cent, but it remains the most dreaded complication in the placement of these catheters with a mortality above 50 per cent. We report two cases of PA rupture after catheter placement. ⋯ They both stopped bleeding after the initial episode and were discharged a few days later. We believe that in the absence of high-risk factors, such as pulmonary hypertension and systemic anticoagulation, PA rupture from a Swan-Ganz catheter can be successfully treated by withdrawal of the catheter and supportive care.
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The American surgeon · Nov 1998
Resource utilization in traumatic brain injury: the role of magnetic resonance imaging.
Cerebral CT scanning is routine in the acute evaluation of traumatic brain injury (TBI) patients. MRI has been reported to identify cerebral lesions better than CT scan. The purpose of this study was to determine whether MRI influenced the acute diagnosis and management of TBI patients. ⋯ The performance of MRI resulted in additional charges of $75,640 or $3,152/patient identified with a new lesion. Although MRI identifies lesions not evident on CT scan, MRI does not alter management plans and is of limited value in the acute management of TBI. MRI may be of medicolegal benefit in cases of child abuse.
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The American surgeon · Nov 1998
Intraoperative radiotherapy in the combined-modality management of pancreatic cancer.
The purpose of this study is to assess the feasibility, clinical tolerance, local control, and survival rates using a combined-modality treatment program of intraoperative radiation, chemotherapy, and external beam radiation for the management of patients with pancreatic cancer. One hundred eighty patients with biopsy-proven adenocarcinoma of the pancreas have been treated by a single surgical practice between 1979 and 1992. Of these, 105 had locally advanced but unresectable primary tumors (stages 2 and 3). ⋯ Patients with pancreatic cancer historically have poor survival and local control rates despite aggressive chemotherapy and radiation. The addition of intraoperative radiation to the combined modality management of pancreatic cancer offers markedly improved survival rates and local control with minimal morbidity for patients with unresectable disease. Intraoperative radiation in the form of IORT can be delivered with a significantly fewer complications than I-125 seed implantation.