The American surgeon
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This essay has been delivered as the William H. Harridge, Jr., M. D. ⋯ The most effective and accurate diagnostic method for disclosing an intra-abdominal abscess appears to be computed tomography (CT). The indications and anticipated success of percutaneous drainage by CT guidance has been presented. The field continues to evolve.
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The American surgeon · Jun 1985
Changes in antithrombin, antiplasmin, and plasminogen during and after cardiopulmonary bypass.
Platelet counts and several clotting parameters, especially antithrombin, alpha 2-antiplasmin, and plasminogen, were determined in 33 patients undergoing cardiopulmonary bypass surgery. Except for Factors VIII and XI, all activities measured fell significantly as the patients were placed on the pump. This initial drop paralleled the drop in hematocrit, i.e., the drop was most likely due to hemodilution. ⋯ Comparisons between activated clotting times (ACTs) and actual heparin levels revealed a good correlation (0.886). Good correlations were also noted when manual factor assays were compared with automated assays using an automated analyzer suggesting the potential use of automation and profiling for these patients. Possible reasons for some of the most commonly encountered postoperative bleeding problems are discussed.
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The American surgeon · May 1985
Comparative StudyActivated clotting time for control of anticoagulation during surgery.
Two groups of patients undergoing extracorporeal bypass were compared for heparin activity and for heparin and protamine dosage. In group I (18 patients), a uniform dosage pattern was neutralized at the end to a normal clotting time. In group II (43 patients), heparin and terminal protamine doses were regulated by activated clotting times (ACT) using a Hemochron (International Technidyne Corp., Metuchen, NJ). ⋯ Other factors that alter heparin activity during bypass revealed no statistical differences. Plasma Hgb was significantly higher in group I, and platelet counts the day following operation were higher in group II. ACT allows tailoring heparin and protamine without the unnecessary dangers of variations in patient response and drug potency.
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Two hundred seventy patients with penetrating chest wall and thoracic injuries were treated at the Metropolitan Nashville General Hospital in a 5.5-year period ending July 1982. Most (250) were males, and the average age was 29.3 years. One hundred thirty-four injuries were the result of gunshot wounds and 18 patients had sustained shotgun wounds. ⋯ All but one of the patients who died following operating room thoracotomy died within 1 hour of admission. When thoracotomy is indicated, it frequently must be performed very soon after admission. The indications for emergency thoracotomy must be known and recognized early if it is to be an effective procedure.
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The multiple trauma patient often presents hypothermic. The infusion of warmed parenteral fluids is one of the least invasive methods of core rewarming the hypothermic patient. This study discusses and describes a safe, efficient method of warming normal saline and lactated Ringer's solution by microwave radiation. ⋯ The technique involved midcycle (60 seconds) interruption with agitation and end-cycle agitation. Intra- and extrabag temperatures were confirmed with three separate thermometers. It was concluded that by following the recommended protocol, hospital personnel could be taught this safe method of rapidly warming nondextrose containing crystalloid.