The American surgeon
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Three cases of hepatic vein and retrohepatic inferior vena caval injuries are reported, and the literature is reviewed. Our experience, coupled with a critical review of the literature reveals that successful vascular isolation of the relatively inaccessible retrohepatic vena cava and/or hepatic veins is the key to optimal surgical management of major injuries to these structures. ⋯ This incision not only gives optimal exposure to the injured site, but also allows easy atrial-caval cannulation. If cross-clamping of the abdominal aorta is necessary, it can be easily done via a median sternotomy.
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The American surgeon · Oct 1982
Case ReportsSecondary burn reconstruction: recent advances with microvascular free flaps, regional flaps, and specialized grafts.
A representative series of cases are presented which demonstrate secondary reconstructive plastic surgery procedures for the burn victim utilizing microvascular free flaps, regional flaps, and specialized skin grafts. The unstable burn scar of the lower extremity could be managed either by a microvascular free-flap transfer, a muscle transfer, a myocutaneous flap transfer, or a reverse dermis graft, or overgrafting. In the present day, there are many treatment modalities available to us. ⋯ Both microvascular surgeons participate in the multiple anastomoses that are required. A microvascular laboratory is essential to the success of a microvascular team, and constant practice is mandatory to maintain and enhance these precision skills. The primary burn surgeon ideally must always keep in mind ways to minimize functional and aesthetic deformity and to continue to improve the quality of life of the burn victim.
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A severely debilitating anaphylactic reaction occurred in a diabetic when protamine was injected following carotid endarterectomy. The patient had been taking neutral protein Hagedorn (NPH) insulin for several months. ⋯ This applies to diabetics, certain blood donors, and previous cardiac surgery patients. Skin testing and specific premedications may be indicated to avoid disastrous consequences.
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The relationships between blood alcohol concentrations and both "osmolar difference" (measured serum osmolality minus expected serum osmolality calculated from serum sodium, serum potassium, blood urea, and blood glucose concentrations) and total serum osmolality have been investigated in severely traumatized patients. Osmolar difference was found to be more strongly correlated to blood alcohol concentration than serum osmolality; however, the error in the slopes of the regression lines was essentially identical (approximately 17%). ⋯ It appears that the production of unidentified osmoles in traumatized patients significantly influences all indirect calculation of blood alcohol by osmometry. A direct determination of blood alcohol should be made whenever possible.
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The American surgeon · Aug 1982
Comparative StudyThe diagnostic usefulness of peritoneal lavage in penetrating trauma: a prospective evaluation and comparison with blunt trauma.
In order to assess the relative utility and reliability of peritoneal lavage as an aid in the management of patients with penetrating trauma, 709 patients (353 penetrating; 356 blunt) with trauma to the lower chest and/or abdomen were evaluated prospectively during 23 consecutive months. There were 144 true-positive, 14 false-positive, 524 true-negative, and 27 false-negative lavages for an error rate of 5.8 per cent (41/709). ⋯ The error rates were comparable in penetrating and blunt trauma; however, false-positive lavages occurred more frequently in blunt trauma and false-negative lavages occurred more frequently in penetrating trauma (p = .0022). Peritoneal lavage can be extremely useful in the initial evaluation of penetrating trauma of all types.