The American surgeon
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The American surgeon · Sep 1993
Case ReportsDysphagia lusoria: aberrant right subclavian artery with a Kommerell's diverticulum.
A retroesophageal right subclavian artery, the most common congenital aortic arch abnormality, is an unusual cause of dysphagia in adults. The embryologic abnormality of the aortic arch is involution of the fourth vascular arch, along with the right dorsal aorta, leaving the seventh intersegmental artery attached to the descending aorta. This persistent intersegmental artery assumes a retroesophageal position as it proceeds out of the thorax into the arm. ⋯ This case presents a middle aged adult with an associated Kommerell's diverticulum and dysphagia. Surgical correction was used to relieve his symptoms and to correct the diverticulum of the proximal right subclavian artery. The embryologic changes that occur are discussed in detail.
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Indwelling venous catheters are invaluable for long-term chemotherapy, antibiotics, and hyperalimentation. However, their placement and chronic use can cause serious complications. This study was done to develop guidelines for minimizing complications of long-term vascular access. ⋯ Line sepsis occurred in 28 instances; this was statistically associated with an abnormal white blood count and with the use of double-lumen catheters (double-lumen catheter sepsis = 18.4%, single lumen = 4.4%, P < 0.01). The morbidity of long-term venous catheters is affected significantly by the route of placement, the number of catheter lumens, and the pre-placement white blood count. As a result of our analysis, we recommend single-lumen catheter placement using the external jugular cutdown route whenever possible.
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The American surgeon · Aug 1993
Multicenter Study Comparative StudyLaparoscopic appendectomy for acute appendicitis: is there really any benefit?
Laparoscopic appendectomy is emerging as a popular treatment modality for acute appendicitis. Although claims have been made to potential superiority over traditional appendectomy, comparisons of operative difficulty, hospital stay, hospital costs, complication rates, postoperative pain, and convalescence have not been well studied. Two hundred consecutive patients presenting with signs and symptoms of acute appendicitis underwent appendectomy. ⋯ Post-op pain, as evaluated by a patient grading scale, was less for laparoscopic appendectomies up to the third post-op week (P = 0.003). The amount of IM pain medication was greater with traditional appendectomy (P = 0.009). Convalescence was significantly shorter with laparoscopic appendectomy as measured by: 1) return to normal household activity (7.8 vs 13.2 days, P = 0.016), 2) returned ability to exercise (19.7 vs 29.0 days, P = 0.009), 3) patient feeling well enough to return to work (14.1 vs 19.2 days, P = 0.032), and 4) actual return to work (15.4 vs 20.5 days, P = 0.038).(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Aug 1993
Hospitalization and injury influence on the prosecution of drunk drivers.
The influence that injury and hospitalization from alcohol-related motor vehicle crashes may have on subsequent prosecution for drunk driving was studied utilizing concurrent controls consisting of three cohorts of drivers. The cohorts were drunk and injured drivers, drunk and not injured drivers, and sober and injured drivers. ⋯ Culpability for the crash was high in the drunk cohorts compared with the sober drivers, and yet there was a statistically significant difference in the conviction rate of injured drunk drivers (59%) compared with uninjured drunk drivers (100%). Injury and hospitalization for drunk drivers after motor vehicle crashes affords protection from prosecution, and may enable ongoing risk-taking behavior by the drunk driver.
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The American surgeon · Aug 1993
Splanchnic mucosal perfusion effects of hypertonic versus isotonic resuscitation of hemorrhagic shock.
A porcine hemorrhagic shock (HS) model was used to assess the splanchnic mucosal and systemic effects of hypertonic versus isotonic crystalloid resuscitation. Animals were bled to a mean arterial pressure of 40 mm Hg for 1 hour and then resuscitated with equivalent sodium loads of LR, 7.5 per cent hypertonic saline (HSS), or 7.5 per cent HSS with 6 per cent Dextran (HSD). Intestinal mucosal blood flow (IMBF) was measured by a laser Doppler flow probe placed on the mucosa of the small bowel. ⋯ There was prompt restoration of IMBF with both HSD (126 31 per cent) and HSS (106 22 per cent) (vs baseline). Resuscitation with LR was associated with a persistent reduction in IMBF (52 16 per cent) despite restoration of mean arterial pressure and cardiac output to baseline levels (P < 0.05). Thus, hypertonic saline solutions may serve an adjunctive role in the resuscitation of hemorrhagic shock by restoring intestinal nutrient blood flow and, thereby, preventing gut barrier impairment, bacterial translocation, and organ failure.