The American surgeon
-
The American surgeon · Aug 1995
Gunshot wounds to the thoracic aorta in the '90s: only prevention will make a difference.
The clinical experience with gunshot injuries to the thoracic aorta at a large urban trauma center was reviewed. Of 1961 patients admitted with gunshot wounds to the chest, 20 sustained injuries to the thoracic aorta. ⋯ Only two patients were stable enough for aortography. Advances in the management of critically injured patients have not improved the outcome with this lethal injury.
-
The American surgeon · Aug 1995
Comparative StudyEffect of resuscitation solutions on the immune status of dogs in hemorrhagic shock.
The purpose of this study is to examine the effects of three different types of fluid resuscitation on the immune system of dogs in hemorrhagic shock. Using a modified Wigger shock model, 18 conditioned male dogs were bled to mean arterial blood pressure of 60 mm Hg for 90 minutes and placed into three groups based on the resuscitative method. Group I: Crystalloid Resuscitation; Group II: Autotransfusion; Group III: Banked Blood. ⋯ Cellular immunity was also affected by transfusion. Total lymphocyte count was increased in Group II on Day 1; however, the three groups were similar with respect to this variable on subsequent days. The absolute T4 helper cell level in Group II was similar to Groups I and III until Day 7, at which time the level became higher in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)
-
The American surgeon · Jul 1995
Randomized Controlled Trial Clinical TrialThe use of tranexamic acid to reduce postoperative bleeding following cardiac surgery: a double-blind randomized trial.
Bleeding during the first 24 hours following cardiac surgery using cardio-pulmonary bypass (CPB) is a serious complication. Attempts to modify the degree of postoperative bleeding with pharmacologic therapy have met with limited success. Tranexamic acid, a potent inhibitor of plasminogen, may decrease the amount of mediastinal bleeding following surgery utilizing CPB. ⋯ Mediastinal blood loss in the treatment and control groups was 382 mL versus 594 mL at 6 hours (P = 0.08), 502 mL versus 848 mL at 12 hours (P = 0.04), and 711 mL versus 1160 mL at 24 hours (P = 0.02). The mean transfusion volumes after 24 hours were 356 mL in the treatment group and 528 mL in the placebo group (P = NS). Prophylactic tranexamic acid infusion decreases mediastinal blood loss following cardiopulmonary assisted cardiac surgery.
-
The American surgeon · Jul 1995
Comparative StudyIs CT portography (CTAP) really useful in patients with liver tumors who undergo intraoperative ultrasonography (IOUS)?
The objectives were to compare the role of CT during arterial portography (CTAP) and intraoperative ultrasound (IOUS) in the management of patients with primary or metastatic liver tumors; to study the ability of CTAP to define resectability before laparotomy in these patients; and to study whether the omission of CTAP in the imaging algorithm resulted in a diminished resectability rate. Eighty-eight consecutive patients with primary or metastatic liver cancer who underwent CTAP and/or IOUS between January 1990 and December 1993 were reviewed. Thirty patients had both CTAP and IOUS and underwent 31 laparotomies (Group I). ⋯ The false positive rate of CTAP was 4/31 (13%). In one case (3%), a false positive result would have precluded a curative resection. CTAP changed management of 4/53 patients (7.5%) by showing unresectable disease.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Laparoscopic techniques have facilitated dissection of the esophageal hiatus by providing clearer visualization and access to this region, thus enabling successful antireflux surgery. We have performed laparoscopic antireflux surgery in 283 patients with symptomatic gastroesophageal reflux disease (GERD) refractory to medical management, including 16 patients with large paraesophageal hernias and six patients who had undergone previous antireflux surgery. Eighty-one per cent (n = 230) underwent a laparoscopic Toupet fundoplication procedure, and 37 had a laparoscopic Nissen fundoplication. ⋯ None of the patients in this series died and the complication rate was only 3.5 per cent. Six patients required reoperation (2.1 per cent), including three of whom originally presented with difficult paraesophageal hernias and did not undergo an initial fundoplication procedure. Thus, laparoscopic fundoplication procedures appear to provide sustained symptomatic relief for patients with refractory gastroesophageal reflux disease, with a rapid recovery and a low incidence of complications.