The American surgeon
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The American surgeon · Sep 1996
ASA physical status and age are not factors predicting morbidity, mortality, and survival after pancreatoduodenectomy.
To evaluate the effects of age and physical status on postoperative complications, American Society of Anesthesiologists-Physical Status score (ASA score) and age were analyzed in patients undergoing pancreatoduodenectomy (PD). Medical records and follow-up results of 69 patients who had undergone PD from 1980 to 1993 at one institution were examined. Clinical variables affecting morbidity and mortality rates were analyzed, and compared between two-aged groups (> or = 70 years (n = 18) and < 70 (n = 51)). ⋯ The morbidity, mortality, and cumulative survival rates were statistically similar in the two age groups. The results suggest that ASA-physical status and age are not limiting factors for PD and do not predict survival. The procedure is safe and worthwhile even in patients more than 70 years of age with the ASA score up to III.
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Computed tomography (CT) is currently the modality of choice in evaluating pancreatic injury in patients suffering abdominal trauma who do not require immediate exploration. The purpose of this study was to determine the reliability of initial CT scanning in the detection of pancreatic trauma. A retrospective review was performed of all patients admitted to two Level 1 trauma centers over a 10-year period. ⋯ The mean pancreatic injury by CT was 0.45 versus 2.0 on exploration (P < 0.001). Injury to the pancreas following blunt trauma is rare. Computed tomography will often miss or underestimate pancreatic injuries that require operative treatment, and normal findings on initial scan should not be relied upon to exclude significant pancreatic trauma.
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The American surgeon · Aug 1996
Unnecessary preoperative investigations: evaluation and cost analysis.
In keeping with national efforts to curb escalating health care costs, the necessity of multiple preoperative investigations was evaluated in 60 randomly selected ambulatory surgery patient records. Necessity for testing was assessed on clinical indications, and overall cost was calculated from the rates at both the local Department of Veterans Affairs Medical Center (VAMC) and a community hospital. ⋯ Education of staff and housestaff is crucial to changing obsolete practice habits. The quality and safety of care would not be compromised by limiting preoperative investigations to only those with clinical indications.
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The American surgeon · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialFailure of antiseptic bonding to prevent central venous catheter-related infection and sepsis.
Infection associated with the use of triple lumen catheters in hospitals is a frequent and serious complication. The prevailing hypothesis for the origin of catheter-related infection (CRI) is bacterial colonization and subsequent infection of the skin insertion site and catheter interface. The recently released ARROWgard catheter contains a bonded synergistic combination of silver sulfadiazine and chlorhexidine, which is thought to render the catheter resistant to bacterial colonization and subsequent sepsis. ⋯ The rate of CRI for the ARROWgard was 10.9 per cent, compared with 12.9 per cent for the standard catheter (P = NS). The rate of CRS for the ARROWgard was 8.7 per cent, compared with 8.1 per cent for the standard catheter (P = NS). The coating of central venous catheters with silver sulfadiazine and chlorhexidine does not reduce the rate CRI or CRS when compared with standard central venous catheters in patients receiving TPN.
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The American surgeon · Jul 1996
Case ReportsHepatic and vena cava resection using cardiopulmonary bypass with hypothermic circulatory arrest.
When large hepatic or retroperitoneal tumors encroach upon hepatic veins or vena cava and make conventional resection hazardous, the most commonly used method of hepatic resection or vena cava reconstruction includes hepatic vascular exclusion, at times with venovenous bypass or aortic occlusion. These techniques result in warm liver ischemia, and may be accompanied by significant systemic hypotension, despite aggressive central venous preloading. Hepatic lobe (two patients) and retroperitoneal sarcoma (one patient) resections were done in a cold, bloodless field without significant complications. ⋯ Systemic circulatory arrest was done at 15 degrees C with isolated retrograde perfusion of the brain through the jugular veins. Hepatic vein and vena cava reconstructions were performed with arrest times of between 30 and 78 minutes. Blood loss was gradual and easily controlled, occurring during the rewarming phase when clot formation was inhibited by cold and heparin.