The American surgeon
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Diffuse lung injury (acid aspiration) and a modest intravascular volume deficit (15% total blood volume) were produced in mongrel dogs. Replacement of lost volume was with shed blood plus an equal volume hydroxy ethyl starch (Group I) or shed blood plus balanced salt solution (3 ml/ml shed blood). Extravascular lung value (EVLW) measurements were used to quantitate edema formation and alveolar arterial oxygen gradient (A-a and O2) was monitored on a reflection of hypoxia. No significant differences were observed in A-a and O2 between groups despite a significantly larger amount of pulmonary edema in Group I (hydroxy ethyl starch).
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The American surgeon · Dec 1983
Measurement of extravascular lung water in sheep during colloid and crystalloid resuscitation from smoke inhalation.
The pathophysiology of pulmonary inhalation injury, a major cause of morbidity and mortality from fires, is poorly understood. To examine the effects of colloid and crystalloid resuscitation on extravascular lung water (EVLW) during a standard smoke inhalation injury, we subjected 12 sheep to 8 minutes of cool pine smoke inhalation. The animals were then resuscitated to a pulmonary capillary wedge pressure (PCWP) of 10 +/- 1.5 mm Hg with either lactated Ringer's solution or plasma protein derivative. ⋯ The increases in EVLW were associated with progressive hypoxia, which was worse in the crystalloid group. In the crystalloid group, COP decreased from 27.3 +/- 0.9 to 14.2 +/- 0.4 mm Hg and intravascular driving force (COP-PCWP) dropped from 17.6 to 3.26 +/- 1.5 mm Hg; COP and COP-PCWP were maintained in the colloid group. These data demonstrate that supporting serum COP minimizes the increase in EVLW with smoke inhalation injury and suggests that smoke inhalation does not lead to a dramatic increase in alveolar capillary membrane permeability to protein.
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Twenty patients sustaining gunshot wounds (GSW) to the buttocks (including one shotgun wound) were treated at two affiliated institutions during the last 5 years. Male patients predominated nine to one. Fifteen patients with extraperitoneal injuries had a benign course. ⋯ The remaining five patients had clinical abdominal findings consistent with severe intra-abdominal injuries (four organs per patient). Although the morbidity was high, there was no mortality in this series. Careful analysis of a bullet's trajectory will allow detection of a possible intraabdominal component of this type of injury, mandating early surgical management.
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The American surgeon · Oct 1983
Randomized Controlled Trial Clinical TrialA prospective randomized study of drained and undrained cholecystectomies.
One hundred twenty-three patients undergoing elective cholecystectomy at USAF Medical Center Keesler were studied in a prospective randomized manner to determine the differences in morbidity and mortality following drained and undrained cholecystectomies. The groups were compared for differences in mortality, wound infection, postoperative fever, and length of hospitalization. One death occurred due to an unrelated cause in an undrained patient. ⋯ A significant difference occurred in postoperative fever between the drained (58%) and undrained (30%) groups. Postoperative hospitalization was also significantly shorter in the undrained group. This study suggests that drainage following elective cholecystectomy is not only unnecessary, but may add to postoperative morbidity and length of hospitalization.
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The American surgeon · Apr 1983
Role of infection in increased mortality associated with age in laparotomy.
Mortality in patients undergoing laparotomy increases with age of the patient. Concomitantly other morbid perioperative factors also are increased, including number and grade of associated system diseases, preoperative infections, severity of disease, emergency operations, post-operative infectious and noninfectious complications, organ failures, and forced secondary operations. ⋯ The majority of others who die have intra-abdominal infections preoperatively or they develop infectious complications and these initiate or perpetuate a train of morbid events that prove fatal after days or weeks of intensive supportive therapy. The inability of elderly patients to avoid or to recover from infection appears to be the most common causative factor in increased mortality with age in laparotomy patients.