The American surgeon
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Scrotal emphysema is mostly iatrogenic and posttraumatic in origin. It usually occurs after surgical operation in the inguinal or the retroperitoneal areas. Three cases of scrotal emphysema secondary to chest problems and one case of scrotal inflation with a syringe and needle are reported. The literature is reviewed and the management is discussed.
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Of all upper extremity emboli, 20 per cent arise from an arterial, not cardiac, source. Therefore, one should always consider an arterial source for embolic occlusion of the axillobrachial axis. Chronic axillary crutch use in the patient with acute, noncardiac embolism of the upper extremity should suggest the diagnosis of crutch-induced axillary artery aneurysm. ⋯ Distal embolectomy should also be performed. Forearm fasciotomy and cervicodorsal sympathectomy should be considered in an adjunctive role. In the absence of compelling contraindications, surgical treatment should be offered at the time of discovery of the aneurysm to prevent continued microembolization to the extremity.
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The American surgeon · Mar 1980
Randomized Controlled Trial Clinical TrialSteroids in heart surgery: a clinical double-blind and randomized study.
The role of steroids in heart surgery was assessed in a group of 95 patients undergoing cardiopulmonary bypass. The treated group (47 patients) received repeated doses (every six hours) of methylprednisolone (30 mg/kg IV) in a double-blind, randomized fashion. The control group (48 patients) received a placebo in a fashion identical to the treated group. ⋯ An improvement in survival was observed in the group receiving methylprednisolone. This finding cannot be explained with the data obtained from this study, in particular, when no other biochemical findings were improved. A more exhaustive hemodynamic and biochemical analysis is necessary to understand the subtle changes that are incurred with the use of steroids for heart surgery.
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During a 24 month period, 30 patients were treated for central vessel trauma (CVT). Injured vessels included all of the major arteries and veins in the chesk, neck and abdomen except the infrarenal aorta. ⋯ Experience with specific injuries is reviewed with commentary on surgical access to difficult areas including the thoracic outlet, suprarenal aorta and inferior vena cava. Common factors in the nine deaths are reviewed with the findings that cardiac arrest at any time during pre- or intraoperative management is uniformly lethal; emergency thoracotomy for control of bleeding carries an expectedly high mortality; cross-clamping of the descending thoracic aorta to control hemoperitoneum has a limit of tolerance of about one hour, and prolonged shock, whether compensated or profound is poorly tolerated and is associated with a high mortality.
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Adult hypertrophic pyloric stenosis is an unusual disease of obscure etiology which causes varying degrees of gastric outlet obstruction. Diagnosis by history, physical examination, and roentgenography is difficult but can be readily made with fiberoptic gastroscopy where a characteristic pyloric "cervix sign" is seen. ⋯ One was treated with distal gastrectomy, and the other was adequately treated by endoscopic dilatation alone. It is suggested that endoscopic dilatation is acceptable as primary therapy in suitable cases.