The American surgeon
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The American surgeon · Dec 1998
Case ReportsMassive spontaneous hemoperitoneum of unknown etiology: a case report.
Massive spontaneous hemoperitoneum has been infrequently presented in the literature. Only very seldom has this phenomenon been described without eventual discovery of an inciting event. We discuss a case of massive spontaneous hemoperitoneum in a 21-year-old healthy white male presenting with nausea, abdominal pain, and mild distention. ⋯ Abdominal exploration revealed free intraperitoneal clotted blood without determination of definitive source of bleeding. No other abnormalities were found. A sound knowledge of potential causes of massive spontaneous hemoperitoneum in the nontraumatized patient with abdominal pain combined with a high index of suspicion and early operative intervention are keys to proper patient management.
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The American surgeon · Dec 1998
Case ReportsSuccessful treatment of exsanguinating aortic injury from a fractured rib.
A 57-year-old man presented in shock after a 15-foot fall from a ladder. A massive left hemothorax was present. He underwent prompt thoracotomy and was found to have a penetrating injury of the descending thoracic aorta caused by a fractured rib. Successful management of this type of aortic injury has not been previously reported.
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The American surgeon · Dec 1998
A new technique for laparoscopic splenectomy with massively enlarged spleens.
Splenectomy is indicated in several hematological disorders and it can be particularly challenging in children with sickle cell disease, splenomegaly, and recurrent sequestration. Over the last 6 months, we have developed a new technique for laparoscopic splenectomy (LS) for hypersplenism and splenomegaly in five children with sickle cell disease. The average age of our patients was 6 years (range, 2-11), and the average weight was 18.7 kg (range, 13.2-30.1). ⋯ Based on these early findings, we conclude that intracorporeal coring of splenic tissue allows for safe and complete laparoscopic removal of very large spleens in small children. It provides expedient recovery and minimal postoperative pain and scarring. This new technique should enable surgeons to perform LS even in patients with massive splenomegaly, eliminating the need for large and cumbersome intracorporeal bags or the creation of additional incisions to remove the spleen.
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The American surgeon · Dec 1998
Immediate breast reconstruction in breast cancer: morbidity and outcome.
Breast reconstruction is frequently performed for and requested by women with breast cancer. There are continued concerns about the safety of this procedure. We reviewed the Medical College of Georgia experience with immediate breast reconstruction to determine overall morbidity and whether premorbid risk factors could predict complications. ⋯ Breast reconstruction may be performed safely for most breast cancer patients. Autologous tissue reconstruction is preferred and carries significantly less major morbidity. Reconstruction should not delay adjuvant chemotherapy.
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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.