The American surgeon
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Breast cancer treatment has undergone significant changes in concept, concurrent with alterations in our understanding of cancer biology and natural history. Within the last 10 years, oncologists have brought into question the traditional Halstedian concepts of the natural history of breast cancer and its appropriate management. The goal of treatment, once a primary cancer is detected in the breast, is to prevent metastasis and subsequent death of the patient. ⋯ Follow-up analysis of the 110 women treated in "standard fashion" was complete in 88 patients 1 to 8 years post-treatment (mean 56 months). Cumulative overall survival was 82 per cent and disease-free survival 83 per cent. Local recurrence was noted in five per cent.(ABSTRACT TRUNCATED AT 250 WORDS)
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The ability to predict amputation following combined orthopedic, vascular and soft tissue trauma to an extremity could eliminate prolonged attempts at salvage of a doomed limb. We reviewed our experience with 48 mangled lower extremities in 46 patients. Twenty-one penetrating wounds and 25 blunt injuries occurred in 37 men and nine women ranging in age from 3 to 59 years. ⋯ Severe extremity injuries require a coordinated approach and decisions regarding amputation require careful judgement. These decisions cannot always be made at the time of presentation or during the initial operation. If after revascularization and skeletal stabilization the extremity is clearly nonviable or remains insensate, then delayed amputation can be performed under more controlled circumstances.
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Fluid resuscitation is considered to be an integral component of the management of hemorrhagic shock. Numerous experimental studies of hypovolemic shock have confirmed the value of volume infusions, but in these models the rate, volume, and duration of bleeding are carefully controlled. The results of such studies may not be applicable to clinical hemorrhage, in which bleeding continues unabated. ⋯ Animals that received either lactated Ringer's or hetastarch had more bleeding into the peritoneal cavity and a greater dilution of clotting factors than animals that received no resuscitation fluids (P < 0.05). In addition, survival was highest in unresuscitated animals, although only the small volume hetastarch group had a significantly lower survival when independently compared with no resuscitation (P < 0.05). These results suggest that in traumatic shock, fluid resuscitation should be minimized until mechanical control of bleeding can be achieved.
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The American surgeon · Dec 1993
Comparative StudySuperoxide dismutase and allopurinol improve survival in an animal model of hemorrhagic shock.
We studied the efficacy of resuscitation with antioxidants in an animal model of hemorrhagic shock. Male Sprague-Dawley rats were anesthetized, and 27 mL/kg of blood was withdrawn from the carotid artery over 2 minutes. The animals remained in hemorrhagic shock for 45 minutes, followed by 1 hour of resuscitation. ⋯ CAT had increased mortality compared to LR, P < 0.01. The efficacy of both SOD and allopurinol in decreasing mortality suggests the importance of superoxide radicals after hemorrhagic shock and resuscitation. These and other antioxidants are potential therapeutic agents in the clinical setting of trauma and hemorrhagic shock.
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Over a 7-year period, 9443 trauma patients were evaluated with 2934 (31%) sustaining chest trauma. Of these, 347 (12%) patients required thoracotomy, with 12 patients undergoing emergency lung resection. Mean age was 23.1 years with mean Injury Severity Score of 32. ⋯ Overall mortality was 33 per cent: 20 per cent for non-anatomical lung resection, 33 per cent for lobectomy, and 50 per cent for pneumonectomy. All survivors fully recovered except for one patient with an associated head injury. Our experience supports the selective use of lung resection, including pneumonectomy, to immediately control hemorrhage and to impact survival in severe chest trauma.