The American surgeon
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The American surgeon · Mar 1998
Case ReportsSuccessful management of calyceal fistula following simultaneous pancreas-kidney transplantation.
Calyceal fistula is an unusual complication of renal transplantation. We report a case of calyceal fistula after simultaneous pancreas-kidney transplant that developed after thrombosis of a lower pole artery. Surgical correction was successfully achieved with a lower pole nephrectomy, closure of the involved calyces, and placement of a ureteral stent and a pedicle of greater omentum graft over the affected parenchyma.
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Appropriate management of renal trauma is controversial. Successful outcome and long term complication rates are not well defined. In an effort to evaluate management options, outcomes, and complications of renal injuries, we conducted a retrospective review of all trauma patients admitted to the trauma service from January 7, 1989 through August 31, 1995. ⋯ The nephrectomy rate among those patients who underwent laparotomy as part of their initial management was 20 per cent, versus 3 per cent for those patients initially managed nonoperatively. Thus, most renal injuries can be managed nonoperatively with a low incidence of complications. The incidence of long-term complications after renal artery injuries and the appropriate management of these patients deserves further study.
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Wound-related complications are common after incisional hernia repair. Prophylactic antibiotic use, placement of subcutaneous drains, and technical factors such as mesh implantation reportedly influence the incidence of these complications. Our aim was to study the incidence of wound complications in incisional hernia repairs and to determine whether use of antibiotics, drains, or mesh influence these rates. ⋯ We conclude that repair of incisional hernias is associated with substantial risk of wound-related complications. Mesh is used for repair of larger and more complex hernias and is associated with increased risk of wound complications. Abnormal fluid collections are the most frequent problem, but the use of drains does not reduce the incidence of these complications.
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The American surgeon · Mar 1998
Case ReportsHigh-output cardiac failure secondary to a brachiocephalic arteriovenous hemodialysis fistula: two cases.
The use of native arteriovenous fistulas for hemodialysis access is important to the success of this form of treatment for patients with end-stage renal disease. Native fistulas have been shown to provide improved longevity and to have lower complication rates when compared to prosthetic graft fistulas. ⋯ Both patients underwent successful transplantation and have required fistula ligation, with subsequent resolution of their cardiac failure. Native fistulas remain the best choice for hemodialysis access, but the clinician should remain aware of the possible untoward hemodynamic effects of these fistulas.
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Penetrating neck injuries constitute a heterogeneous group. Two different classifications of zones of the neck exist in trauma literature. Injuries crossing the midline are not accurately reported. ⋯ We emphasize the lethal potential of transcervical GSWs and SGWs. We suggest that these particular injuries be reported separately. We recommend the universal adoption of one system of classification of neck zones.