The American surgeon
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The American surgeon · Jul 2000
Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions.
Metastatic tumors to the liver account for the majority of hepatic neoplasms. Improvement in resection has been shown to be beneficial and has remained the treatment of choice, carrying a 5-year survival rate of approximately 20 to 30 per cent. In evaluating candidates for surgery, intraoperative assessment for resectability is a key factor and dictates surgical approach, as well as patient prognosis. ⋯ One patient was found to have benign hepatic cysts, and no resection was performed. The use of IOUS modified the management of 44 per cent of our patients with liver metastases. IOUS should be routinely used in patients undergoing liver resection for metastatic liver disease.
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The American surgeon · Jul 2000
The influence of anesthetic technique on perioperative blood pressure control after carotid endarterectomy.
The optimal anesthetic for use during carotid endarterectomy has been a matter of debate for three decades. The goal of this study is to evaluate the influence of anesthetic technique on perioperative hemodynamic instability after carotid endarterectomy. This study is a retrospective chart review and was performed in a community teaching hospital. ⋯ Regional anesthesia required lower doses of antihypertensive medication in the early postoperative period when compared with general anesthesia. The doses of vasoactive medications used had no significant impact on the complication rate. Regional anesthesia allowed for shorter stay in both the intensive care unit and total hospital stay.
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The American surgeon · Jul 2000
Nonoperative management of blunt splenic injury in adults 55 years and older: a twenty-year experience.
The nonoperative management of splenic injury secondary to blunt trauma in older patients remains controversial. We have reviewed our experience from January 1978 to December 1997 with selective nonoperative management of blunt splenic injury in adults 55 years and older. Criteria for nonoperative management included hemodynamic stability with any transient hypotension corrected using less than 2,000 cm3 crystalloid infusion, a negative abdominal physical examination ruling out associated injuries, and a blood transfusion requirement of no more than 2 units attributable to the splenic injury. ⋯ None of the 18 patients who met the criteria for nonoperative management "failed" the protocol, and none were taken to the operating room for abdominal exploration. Two patients (11%) died of associated thoracic injuries after lengthy hospital stays, one at 10 days and one at 24 days. We conclude from our data that nonoperative management of blunt splenic injury in patients age 55 years and older is indicated provided they are hemodynamically stable, do not require significant blood transfusion, and have no other associated abdominal injuries.
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The American surgeon · Jul 2000
Nonsurgical management of solid abdominal organ injury in patients over 55 years of age.
Age greater than 55 is often stated to be a contraindication to nonoperative management of intraperitoneal solid organ injury, based upon failures in early experiences of nonoperative therapy. Refinements in the criteria for nonoperative management of hepatic and splenic injuries have yielded improved success rates compared with those in initial reports, raising questions as to the validity of an age-related contraindication. A retrospective chart review of patients more than 55 years of age sustaining blunt hepatic and/or splenic injury at two urban Level I trauma centers was performed. ⋯ All but one of the 37 patients were successfully treated nonoperatively, for a 97 per cent success rate. We conclude that hemodynamically stable patients more than 55 years of age sustaining intra-abdominal injury can be observed safely. Age alone should no longer be considered an exclusion criterion for nonoperative management of intra-abdominal solid organ injury.