The American surgeon
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The traditional surgical treatment of gastric volvulus involves upper abdominal laparotomy with gastric detorsion, fixation, and, when present, repair of associated diaphragmatic hernia. We describe a case of organoaxial gastric volvulus associated with a paraesophageal hernia in a poor risk patient, which was successfully treated with laparoscopic detorsion and percutaneous endoscopic gastropexy. This approach avoided the morbidity of a laparotomy and allowed the rapid recovery of gastric function.
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The American surgeon · May 1993
Perforated gastric and duodenal ulcer: an analysis of prognostic factors.
A review of patients treated operatively for perforated ulcer was undertaken to determine factors that independently predict mortality and morbidity. From 1980 to 1989 84 patients were treated with operative mortality and morbidity rates of 18 and 37 per cent, respectively. Patients with gastric ulcer were significantly older and were more likely to have concomitant medical problems, to use steroids, and be hospitalized at time of their perforation. ⋯ Patient outcome from operation for perforated ulcer is dependent on preoperative conditions and appears to be independent of surgical procedure performed. There was no benefit to simple closure of a perforated ulcer. Definitive procedures of perforated ulcers are associated with lower ulcer recurrence and therefore are advocated to treat perforation.
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Between July 1, 1987 and June 30, 1990, 30 consecutive deliberately scalded children were studied prospectively. Purposes of the study were to characterize the scald-abused child and address the management problems specific to this group. Mean age was 22.5 months. ⋯ In 30 per cent, diarrhea complicated nutrition support, wound, or autograft care. Four (13.3%) patients with a mean burn size of 32.3 per cent of the total body surface area, diarrhea, and burns involving the buttocks, perineum, and external genitalia died of burn wound sepsis; three of these had Gram-positive bacteremia (Staphylococcus aureus and enterococcus). Burn wounds exposed to the fecal stream (buttocks) should be examined carefully and frequently for signs of infection, particularly in those patients with diarrhea.
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The American surgeon · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialInjury severity dictates individualized antibiotic therapy in penetrating abdominal trauma.
Antibiotics play a crucial role in reducing the risk of postoperative infection in patients suffering penetrating abdominal trauma. The infection rate for patients with these injuries ranges from 7% to 16%. Single agents with broad-spectrum activity have proven efficacy, but dosage and duration are still controversial. ⋯ There was a significant increase in infection rate for all antibiotics except ceftizoxime in Group B compared with group A. The penetrating abdominal trauma index was significantly higher in all patients who developed infection for all antibiotics. In addition, if the surgical wound was closed primarily, patients with colon injuries developed wound infections 71% of the time, and those with small-bowel injuries did so 30% of the time.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Jan 1993
Comparative StudyDecreased red blood cell deformability and impaired oxygen utilization during human sepsis.
Sepsis is characterized by decreased microcirculatory flow and increased peripheral shunting. Previous studies have shown red blood cell deformability (RCD) is decreased during sepsis. The purpose of this study was to evaluate the effect of changes in RCD on hemodynamics and oxygen utilization during sepsis. ⋯ No significant correlation existed between RCD and cardiac index or systemic vascular resistance. Patients with low RCD demonstrated impaired oxygen utilization; changes in RCD correlated closely with changes in DA-VO2 and MVO2. These data suggest that decreased RCD may have an etiologic role in the impaired oxygen utilization that occurs during sepsis.