The American surgeon
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Percutaneous drainage of an intra-abdominal abscess is utilized frequently. To evaluate its effectiveness at our institution over 16 months, 18 patients (mean age 49 years) who underwent radiologically directed percutaneous drainage of intra-abdominal abscesses were retrospectively reviewed. The abscesses were postoperative in 14 patients (laparotomy, 5; appendectomy, 4; colectomy, 3; hysterectomy, 2). ⋯ CT-directed percutaneous drainage of intra-abdominal abscesses provides an alternative to immediate surgical intervention. The preliminary findings from this study suggest a limited application of this intervention in one-third of patients. Further detailed analysis of this patient group is required to delineate guidelines for identifying those patients where percutaneous drainage is unlikely to be successful.
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Ultrasound refers to sound of any frequency greater than 20 kilohertz; that is, above the frequency for which humans can normally hear. All sound, including ultrasound, travels through different tissues at different rates of speed. The point at which adjacent tissues with different speeds of sound meet is referred to as an acoustic interface. ⋯ The resolution of ultrasound images of the breast has been greatly improved by computer-enhancement capabilities and the availability of high-frequency transducers. Although the detailed imaging of modern ultrasound allows for satisfactory evaluation of most breast lesions, there are a variety of artifacts inherent to breast ultrasound of which one must be cognizant, so as to avoid misinterpretation. This article will address a number of these issues, thereby presenting an introduction to the basic physics and principles relevant to breast ultrasound.
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The American surgeon · Jan 1996
Comparative StudyLaparoscopic L5-S1 diskectomy: a cost-effective, minimally invasive general surgery--neurosurgery team alternative to laminectomy.
Laparoscopic L5-S1 diskectomy (LLD) is a promising new technique for managing disabling pain from herniated lumbar disks. It is unknown, however, whether the clinical results of LLD are superior to those of traditional laminectomy (LAM). This study was undertaken, therefore, in order to compare LLD and LAM in the management of L5-S1 disk herniation unresponsive to conservative treatment measures. ⋯ LLD is a safe, cost-effective, minimally invasive operation for managing disabling L5-S1 disk herniation. Compared with LAM, LLD reduces blood loss, length of stay, rehabilitation time, and patient charges, and improves long-term functional and pain-free status. LLD should be considered as an alternative to LAM for patients with herniated L5-S1 intervertebral disks unresponsive to conservative management.
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The American surgeon · Jan 1996
Comparative StudyPostoperative pulmonary complications and morbidity after abdominal aneurysmectomy: a comparison of postoperative epidural versus parenteral opioid analgesia.
Patients undergoing aortic aneurysm repair have a high prevalence of coexisting cardiac and pulmonary disease, and the postoperative recovery is especially delayed by pulmonary complications. A review of all elective abdominal aneurysm repairs over a 29-month period was undertaken to evaluate the effectiveness of postoperative epidural analgesia in decreasing morbidity and mortality, and specifically pulmonary complications. Patients were placed into two groups; Group 1 (34 patients) used an epidural catheter for postoperative pain control, and Group II (31 patients) used standard parenteral opioid analgesia. ⋯ Although no significant difference (P = > 0.05) was seen in decreasing time to ambulation (P = 0.054), average time required on the ventilator (P = 0.053), or hospital days (P = 0.181), all of these did show a trend in favor of epidural catheter utilization. There were no complications or infections related to the use of the epidural catheter during this study period. In conclusion, the use of an epidural catheter for postoperative pain control has been shown to decrease time of intubation, time in the ICU, number of cardiac and pulmonary complications, which should lead to an overall decrease in hospital charges after elective repair of abdominal aortic aneurysms.
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Jejunal diverticular (JD) perforation is an uncommon cause of acute abdominal pain in the elderly. From 1971 to 1994 we treated 13 such patients, 9 men and 4 women, with a mean age of 68 years. All patients experienced sudden onset of abdominal pain, nausea and vomiting, and leukocytosis (range of white blood cell counts, 14,000-21,000). ⋯ In conclusion, JD perforation is an uncommon and frequently overlooked cause of acute abdominal pain in elderly patients. Timely operative intervention and resection of the involved jejunum are the keys to a successful outcome. Because the presentation and physical findings of perforated JD can be highly variable, a history of preexisting JD should arouse suspicion for JD perforation as the etiology of acute abdominal pain in the elderly.