The American surgeon
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Amrinone is a noncatecholamine inotropic agent used clinically in the management of heart failure. The purpose of this study was to determine if intravenous (i.v.) infusion of amrinone has beneficial effects during resuscitation from experimental hemorrhagic shock. Effectiveness was defined as significantly improved survival rate. ⋯ Resuscitation in placebo (control) animals was with 54 ml/kg (2 times the hemorrhage volume) Lactated Ringer's solution over 1 hour, whereas resuscitation in drug-treated animals was with a 0.75 mg/kg bolus amrinone over 3 minutes followed by 54 ml/kg Lactated Ringer's solution and 5 ug/kg/min infusion over 1 hour. Results were that resuscitation with amrinone significantly increased MAP, tissue pO2, and survival over resuscitation with Lactated Ringer's alone (P < 0.05). In both trials, survival rates increased by more than 66 per cent in the amrinone groups.
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The American surgeon · Sep 1994
Review Case ReportsAsymptomatic pneumoperitoneum diagnostic and therapeutic dilemma.
The most common cause of pneumoperitoneum is iatrogenic postsurgical free air that enters the abdominal cavity during laparotomy. In these patients, pneumoperitoneum usually resolves within the first week of surgery and laparoscopic procedures. In patients who have not had recent laparotomy or laparoscopy, pneumoperitoneum indicates rupture of an intra-abdominal viscus in about 90 per cent of the time. ⋯ We report here six patients who presented to Howard University Hospital with nonsurgical pneumoperitoneum. Four of these patients underwent negative laparotomies and one died postoperatively. The most common causes of benign pneumoperitoneum are discussed and a review of the literature is presented.
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The American surgeon · Aug 1994
Inguinal herniorrhaphy under local anesthesia: a study of intraoperative tolerance.
Tolerance to inguinal hernia repair under local anesthesia was prospectively evaluated in a consecutive series of 41 patients who underwent hernia repair with local infiltration of 0.75 per cent lidocaine. Intraoperative discomfort was measured by an analog visual scale. All complications were also recorded. ⋯ There was no operative mortality. Normal diet was tolerated the day of surgery in 39 patients, and 30 were discharged from the hospital on the same day. Our series supports good tolerance and a low complication rate when inguinal herniorrhaphy is performed under local anesthesia.
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The American surgeon · Aug 1994
Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome.
The medical records of 91 patients who underwent thyroidectomy from 1990 to 1993 were reviewed to evaluate airway management and operative morbidity in patients with marked thyroid enlargement. Twenty-nine patients with marked thyroid enlargement were identified: 13 unilateral, defined by a weight of > or = 40 g (mean 122 g, range 41-380 g), and 16 bilateral, defined by a weight of > or = 80 g (mean 160 g, range 82-404 g). Twenty-five patients had compressive symptomatology, 18 had tracheal narrowing and/or displacement, 19 had substernal extension, and one had superior vena cava syndrome. ⋯ Six (21%) of 29 patients had temporary hypocalcemia compared to eight (13%) of 62 patients with lesser thyroid enlargement (P = 0.36). One patient with an unresectable follicular carcinoma died from aspiration pneumonia three weeks following tracheostomy placement. Marked thyroid enlargement and upper airway compression is predominantly caused by benign disease; however, when there is associated recurrent laryngeal nerve dysfunction, carcinoma is more common.(ABSTRACT TRUNCATED AT 250 WORDS)
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To assess the therapeutic role and cost effectiveness of resuscitative thoracotomy in an urban trauma center, a retrospective review of thoracotomies (n = 273) performed in a trauma unit between 1986 and 1992 was undertaken. A total of 252 thoracotomies were performed for penetrating injuries (92%), and 21 (8%) were performed for blunt trauma. Ten neurologically intact survivors (3.7%) were identified. ⋯ Total charges during the study period for resuscitative thoracotomy were approximately $932,000. This represents an expenditure of $93,000 per successful thoracotomy. If thoracotomy was limited to patients sustaining penetrating trauma who demonstrated signs of life, total charges would be approximately $201,367, representing an expenditure of $20,137 per successful thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)