The American surgeon
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Trauma complicating pregnancy represents a significant threat to maternal survival and successful pregnancy outcome. Combining trauma center and perinatal center capabilities may provide improved outcome for pregnant trauma victims. The authors report their experience with 39 patients over a 10-year period to identify factors that influenced pregnancy outcome. ⋯ Unsuccessful pregnancy was associated with significantly higher injury severity score (ISS); regional abdominal abbreviated injury scores (AIS) and hospital charges; longer hospital and intensive care unit lengths of stay; a higher incidence of intubation and placenta abruptio; and a lower admission systolic blood pressure. Fetal ultrasound or Doppler were routinely used and contributed to trauma management. These findings support close cooperation and coordination of trauma and perinatal services to achieve optimal maternal and pregnancy outcomes.
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The American surgeon · Sep 1992
Comparative StudyAutotransfusion in trauma: a comparison of two systems.
Autotransfusion is a potentially valuable tool in the resuscitation of hypovolemic trauma patients; its acceptance in this setting has been limited by fears of the induction of coagulopathic and septic complications. It has been inferred that the addition of a cell washing step would obviate these concerns but at the cost of speed. To assess the validity of these concerns, we have retrospectively compared two autotransfusion devices: one without (the modified Bentley device) and one with (the Baylor Rapid Autologous Transfusion system) a cell washing step, over a 48-month period. ⋯ Overall, the device returned 0.82 units of washed, packed red blood cells for every unit of banked blood used. Overall mortality was 26 per cent, and 30 per cent of survivors had complications. While we have been unable to demonstrate an advantage of the cell washing step, there is no evidence that this step in this unit limited the rate or volume of autologous blood replacement.
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The American surgeon · Aug 1992
Comparative StudyThe use of epidural anesthesia and analgesia in aortic surgery.
During a 3-year period, sixty-four consecutive patients, who had elective aortic reconstruction were investigated to determine whether epidural anesthesia and analgesia, combined with light general anesthesia, would lower the rate of perioperative complications in this high-risk group of patients. The epidural group comprised 32 consecutive patients who had surgery during the 20-month period from July 1986 to December 1987. These patients were compared with the previous 32 patients who had aortic reconstruction at Huntington Memorial Hospital (Pasadena, CA) using conventional general anesthetic techniques. ⋯ There was no statistically significant difference in cardiovascular morbidity, length of hospital stay, or intensive care unit stay between the two groups. There was however, a striking decrease in respiratory complications and length of intubation in the epidural anesthesia group (P less than 0.005). The authors conclude that epidural anesthesia and analgesia, combined with a light general anesthetic may confer benefits over conventional general anesthesia in patients undergoing aortic surgery.
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The American surgeon · Aug 1992
Comparative StudyRisk factors for myocardial infarction after distal arterial reconstructive procedures.
This study identifies the preoperative, intraoperative, and postoperative factors associated with perioperative myocardial infarction (MI). The records of all patients who had distal vascular reconstructive procedures who sustained a perioperative MI were retrospectively reviewed from 1977 to 1990. ⋯ Diabetes, heart murmur, and previous major amputations were identified as significant risk factors for the development of a perioperative MI. No laboratory or cardiographic data correlated with an increased risk, and the Goldman Index was inadequate in predicting perioperative MI risk.
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The American surgeon · Aug 1992
Case ReportsPost-traumatic pseudoaneurysm of the left hepatic artery initially appearing as upper gastrointestinal hemorrhage secondary to hepatic artery-duodenal fistula. A case study.
Post-traumatic hepatic artery pseudoaneurysm initially appearing as upper gastrointestinal hemorrhage secondary to rupture in the duodenum is rare. Diagnosis was made on selective arteriogram and the patient was managed successfully by ligating the feeding vessel to the aneurysm.