The American surgeon
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The American surgeon · Aug 1986
Case ReportsPartial cardiopulmonary bypass for core rewarming in profound accidental hypothermia.
Six cases of treatment of severe accidental hypothermia using cardiopulmonary bypass for core rewarming are reported and eleven cases from the literature are analyzed. Thirteen patients survived. Overall survival was more likely in patients who had vital signs initially. ⋯ Immediate CPB for rewarming is recommended for patients in ventricular fibrillation with core temperatures below 30 C. Prolonged external cardiac massage (ECM) should not be used. The value of surface rewarming and non-CPB core rewarming methods remains undefined.
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The American surgeon · Jul 1986
Epidural morphine by continuous infusion with an external pump for pain management in oncology patients.
Ten patients with advanced malignancies and severe pain were given epidural morphine (EDM) by continuous infusion. The pain had been treated previously with large doses of oral or parenteral narcotics, without success. The pain was disabling in all the cases. ⋯ One patient developed urinary retention. EDM by continuous infusion produced constant pain relief for prolonged periods. This technique is safe for analgesia in oncology patients and suited for outpatient management.
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The American surgeon · Jun 1986
Urgent and emergent re-laparotomy in trauma. A preventable cause of increased mortality?
In a 2-year period, 96 patients required laparotomy for trauma at the University of Kansas Medical Center. Fifteen patients required a total of 25 emergent and urgent reexplorations. ⋯ Factors predisposing to complications requiring re-laparotomy include multi-system trauma, blunt abdominal injury, and inadequate or delayed initial resuscitation and operation. Recognition of these factors and resuscitation and operation by personnel experienced in trauma care should lead to lower reoperation rates, and decreased morbidity and mortality when reoperation is necessary.
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The American surgeon · May 1986
Case ReportsThe study and correction of human gait by electrical stimulation.
To gain a better understanding of the functions that the calf and vastus muscles perform in the human walking gait the author systematically increased the contractions of these muscles separately and in combination by applying Functional Electrical Stimulation (FES) to them, during walking tests performed by a subject with nonpathological gait, and a patient with a hemiplegic gait. A four-channel stimulator was used with foot switch activated control systems, which accurately sequenced the FES pulses and timed them in relation to the footswitch contacts. ⋯ Strengthened vastus muscle contraction increased the amount and duration of stance phase knee extension, and interacted with the calf FES to increase the amount of heel rise at the push off. In the hemiplegic gait calf FES resulted in some increased knee flexion and ankle plantar flexion after the opposite heel strike, but a persistent lower limb extensor synergy prevented knee flexion from occurring simultaneously with plantar flexion and a heel rise, while the hemiplegic limb was still weight bearing.
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The American surgeon · Mar 1986
Long-term, intermittent percutaneous administration of epidural and intrathecal morphine for pain of malignant origin.
Eight patients with intractable pain of malignant origin were treated by the surgical implantation of externalized catheters for percutaneous injection of morphine into the spinal epidural or the cerebral intraventricular space. Follow-up ranged from 48 hr to 1 yr. Four catheters (50%) malfunctioned mechanically and were repaired. ⋯ One patient developed paradoxical responses and discontinued catheter use. Every patient enjoyed excellent relief for a significant time with full preservation of mental capacities. The attractive simplicity of this morphine delivery system deserves further study.