The American surgeon
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The American surgeon · Jul 1999
The effect of peritoneal contamination on wound strength of small bowel and colonic anastomoses.
Primary bowel repair in the face of peritoneal soilage is still a controversial area. Previous studies using the rat model have demonstrated a difference in new collagen synthesis after 24 hours of peritoneal contamination. Currently, the effect of short-term fecal contamination of the peritoneal cavity on anastomotic healing and strength is not known. ⋯ There was no significant difference in maximum anastomotic wound strength or hydroxyproline content between 12-hour CLP and 12-hour control group for both small bowel and colon anastomoses. Short-term peritoneal soilage (12-hour) does not significantly effect the maximum tensile strength or hydroxyproline content of primary small bowel or colonic anastomoses in this model. This study suggests that short-term fecal contamination of the peritoneal cavity may not be a contraindication to primary bowel anastomosis.
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The American surgeon · Jun 1999
Review Case ReportsCombined blunt cardiac and pericardial rupture: review of the literature and report of a new diagnostic algorithm.
The spectrum of blunt cardiac injury varies from the asymptomatic cardiac concussion to the immediately fatal cardiac rupture. Although the majority of victims sustaining blunt cardiac rupture die before receiving medical attention, some survive to evaluation. The diagnosis of cardiac rupture, if established, typically results from the signs and symptoms of pericardial tamponade. ⋯ In neither of the cases did existing institutional algorithms for blunt cardiac injury assist in establishing the diagnosis before the acute demise of the patient. The presence of a coexisting pericardial injury in these patients with blunt cardiac rupture obscured the diagnosis, leading to the deaths of these patients. A discussion of these two cases and review of the literature is provided with recommendations for diagnostic algorithms in patients sustaining blunt thoracic trauma with possible cardiac and pericardial injury.
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The American surgeon · Jun 1999
"Blind" placement of long-term central venous access devices: report of 589 consecutive procedures.
Placement of long-term central venous access devices, such as Hickman catheters and implanted subcutaneous ports, has traditionally been performed in the operating room with fluoroscopy. This study reports our experience with percutaneous placement of these devices in the outpatient clinic setting without the use of real-time imaging. Results were generated from a prospective database of all adult patients undergoing placement of central venous access in the outpatient clinic of the Wake Forest University Baptist Medical Center. ⋯ Late complications, including infection and thrombosis, occurred in 9 per cent. The average procedure-related charge for placement of a single-lumen central venous port in the outpatient clinic was $1691 versus $4559 in the operating room and $3890 in the radiology department. We conclude that routine placement of long-term central venous access devices in the outpatient clinic, without the use of real-time imaging, yields acceptable success rates and may have economic advantages over procedures performed in the operating room or radiology department.
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The American surgeon · Jun 1999
Sentinel node biopsy and cytokeratin staining for the accurate staging of 478 breast cancer patients.
Sentinel lymph node (SLN) mapping is an effective and accurate method of sampling the axillary nodal basin for metastatic disease. The SLN is the first node to receive afferent lymphatic drainage from the primary tumor. Lymphatic mapping and SLN biopsy have allowed pathologists to perform a more detailed examination of the SLN(s) and, therefore, provide more accurate staging of the regional lymphatic basin. ⋯ Undetected micrometastatic disease to the regional lymph nodes may account for the significant proportion of stage I breast cancer treatment failures. Furthermore, the ability to accurately stage the axilla by using lymphatic mapping techniques, SLN biopsy, and more sensitive assays may help identify a subgroup of truly node-negative patients with invasive breast cancer who can avoid the morbidity associated with a complete axillary dissection or systemic chemotherapy. Finally, those patients found to have micrometastatic disease to the regional lymph nodes can be treated appropriately in a more selective fashion.
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The American surgeon · May 1999
Randomized Controlled Trial Clinical TrialCan oral metronidazole substitute parenteral drug therapy in acute appendicitis? A new policy in the management of simple or complicated appendicitis with localized peritonitis: a randomized controlled clinical trial.
To demonstrate the efficacy of oral metronidazole (OM) in simple or complicated appendicitis with localized peritonitis, a randomized prospective study was carried out in 1083 patients, ranging in age from 4 to 50 years (mean age, 21.38). The patients were randomly divided into two groups. The study group (SG) (524 patients) received OM (500 mg for adults, 7-10 mg/kg if less than 15 years) 2-3 hours before operation. ⋯ In uncomplicated cases, hospital stay and hospital charge were both almost the same in both groups. However, length of hospitalization was nearly 1 day shorter and hospital cost per day was about 30 per cent less in complicated cases in the SG as compared with the CG. Conclusively, OM may not only substitute parenteral antibiotics in acute appendicitis as a prophylactic agent, but it may also be used as a cost-effective drug and is more convenient to the patient.