The American surgeon
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Telemedicine (TM) using closed-circuit television systems allows specialists to evaluate patients at remote sites. Because an integral part of the vascular examination involves palpation of peripheral pulses the applicability of TM for the evaluation of vascular surgery patients is open to question. This study was carried out to test the hypothesis that TM is as effective as direct patient examination for the development of a care plan in vascular patients. ⋯ We conclude that the TM evaluation of vascular patients is accurate and is as effective as on-site evaluations for a variety of vascular problems. Important adjuncts to enhance the success of a TM evaluation are physician experience with the technology and the presence of a knowledgeable on-site assistant. This technology can be easily adapted to other clinical situations.
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The American surgeon · Apr 2001
Comparative StudyOpen versus percutaneous dilatational tracheostomy: efficacy and cost analysis.
The economic advantages of percutaneous dilatational tracheostomies versus open tracheostomies in the operating room have been thoroughly evaluated. We are now reporting our comparison of the costs and charges of percutaneous dilatational tracheostomies with those of open bedside tracheostomies at our institution. The current literature comparing the two open techniques and the percutaneous method of placing tracheostomies was reviewed and the charges and costs for these procedures at our institution were compared. ⋯ For the 150 to 180 tracheostomies done each year at our institution utilization of the open technique at the bedside results in a cost savings of approximately $31,500 and a charge savings of $109,000 compared with the percutaneous dilatational tracheostomy. Both the open bedside and percutaneous dilatational methods are reasonable and safe options. However, the open bedside tracheostomy is a better utilization of resources and is more cost effective, and it is the procedure of choice at our institution.
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The American surgeon · Apr 2001
Intraoperative and early postoperative gastric intramucosal pH predicts morbidity and mortality after major abdominal surgery.
The present study was undertaken to investigate the correlation between the intraoperative and postoperative gastric intramucosal pH (pHi) with important perioperative variables and to explore any potential relationship of the measured pHi with the patients' postoperative course. A prospective study was carried out in a group of 48 patients who underwent major abdominal operations over an 8-month period at St. John Hospital and Medical Center. ⋯ At a cutoff point of 7.32 gastric pHiOR gave a sensitivity of 69 per cent and specificity of 97 per cent for predicting postoperative complications as well as a sensitivity and specificity of 67 per cent and 81 per cent for predicting death. Intraoperative and early postoperative gastric pHi is a reliable predictor of patient outcome after major abdominal operations. Splanchnic ischemia may play an important role in determining early complications and survival; therapy guided by the gastric pHi might improve outcome.
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The American surgeon · Apr 2001
Case ReportsTransfemoral extraction of an intracardiac bullet embolus.
Missiles may reach the heart via direct penetration of the thoracic cavity or indirectly by means of the venous circulation. Often the hemodynamic stability of the patient dictates the approach that is used not only to retrieve the projectile but also to repair associated life-threatening injuries. The case of a 40-year-old man with an intracardiac missile after a gunshot wound to the right gluteal area is presented along with the transfemoral technique used to recover an intracardiac projectile. This approach may be used instead of thoracotomy for missile extraction in stable patients.
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In 1996 we reviewed the literature and reported on our own series of emergency cricothyrotomy (EC) patients. The success rate in obtaining an airway was very good. The survival rate was also acceptable. ⋯ In most cases these problems were due to the underlying disease process. EC is effective in obtaining an airway with a low incidence of later severe airway problems. However, many of these patients do poorly overall.