The American surgeon
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The American surgeon · Dec 1996
Clinical TrialChanges in oxygenation and compliance as related to body position in acute lung injury.
Body positioning during mechanical ventilation for acute lung injury has not been studied in a detailed manner. We evaluated the relationship between oxygenation, compliance, and body position during mechanical ventilation of patients with acute lung injury (ALI). ⋯ Data obtained in each position (after a 45-60 minute equilibration time) included static pulmonary compliance and partial pressure of oxygen from arterial blood gas sampling. Oxygenation is not improved and compliance is adversely affected by upright body positioning as compared to the supine position in patients receiving mechanical ventilation for ALI.
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The American surgeon · Dec 1996
Case ReportsPericardial tamponade and death from Hickman catheter perforation.
In February 1995, a 56-year-old female was taken to the operating room for routine placement of a Hickman catheter. Her internist planned palliative chemotherapy for metastatic breast cancer. Using the Seldinger technique, the right subclavian vein was entered and a Hickman catheter was placed. ⋯ Resuscitative efforts, including chest tube placement and pericardiocentesis, were unsuccessful. Autopsy findings included perforation of the superior vena cava, with extension of the catheter in the pericardial sac and associated effusion. Despite the low reported incidence of perforation during placement of central venous catheters, we recommend confirmation of placement by fluoroscopy and instillation of radiopaque dye because of the high mortality associated with this complication.
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The American surgeon · Nov 1996
Randomized Controlled Trial Clinical TrialEffect of intramuscular intraoperative pain medication on narcotic usage after laparoscopic cholecystectomy.
The purpose of this randomized, double-blind, clinical trial was to determine whether intraoperative, intramuscular (IM) injections of meperidine or ketorolac would improve postoperative pain relief in patients undergoing elective laparoscopic cholecystectomy. A total of 125 patients were entered into five study groups: 1) (N = 23) control placebo; 2) (N = 31) meperidine 100 mg IM intraoperative preprocedure; 3) (N = 20) meperidine 100 mg IM intraoperative postprocedure; 4) (N = 25) ketorolac tromethamine 60 mg IM intraoperative preprocedure; 5) (N = 26) ketorolac tromethamine 60 mg IM postprocedure. All groups were analyzed by comparing the amount of pain medication received in the recovery room, the time until first oral pain medication was requested, the overall amount of pain medication used in the first 24 hours, the percent requiring IM medication, and the pain score ratings from each group. ⋯ Both Groups 4 and 5 had decreased postoperative narcotic usage. Finally, the analogue pain scores showed that both ketorolac groups had significantly less postoperative pain compared to control, whereas the meperidine groups showed no improvement in postoperative pain relief. Intraoperative ketorolac given preprocedure or postprocedure significantly improved postoperative pain management and facilitated the transition to oral pain medication.
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The American surgeon · Nov 1996
Review Case ReportsIntussusception in an adult secondary to an inverted Meckel's diverticulum.
Intussusception secondary to an inverted Meckel's diverticulum is considered to be a rare occurrence. The pathophysiology of the disease process results in a complicated clinical picture of chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms that may lead to an unnecessary delay in diagnosis. ⋯ The methods of diagnosis and the salient concepts in the surgical management of intussusception are discussed. Special features regarding the pathophysiology and treatment of an inverted Meckel's diverticulum acting as an intussusception are also reviewed.
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Pulmonary contusion is the most common injury identified in blunt chest trauma. Despite improvements in diagnostic imaging and critical care, the associated mortality has not appreciably changed over the last three decades. Parenchymal injury ultimately manifests as alveolar collapse and lung consolidation. ⋯ Avoiding fluid overload, oxygen therapy, and a low threshold for mechanical ventilation are useful therapeutic guidelines. Complications include pneumonia and adult respiratory distress syndrome, which may occur in up to one half of all cases. Pulmonary contusion is a serious injury that may complicate patient management as well as pose a vital threat.