Journal of the American College of Surgeons
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Conservative management with intrapleural drainage and total parenteral nutrition (TPN) has been the first choice of treatment for postoperative chylothorax. With this approach, however, it usually takes several weeks for the chylothorax to resolve and it is sometimes unsuccessful. In this study, we reviewed seven patients who had chylothorax develop after pulmonary resection for primary carcinoma of the lung. ⋯ One patient did not consent to the "one-week trial" and underwent operative treatment on the third postoperative day. Two patients had chylous leaks less than 100 mL/day or less than 15 percent of the maximum daily chylous leak after one week observation. Conservative management with TPN was continued in these patients for two more weeks and operation was performed in one on the 20th day and in the other on the 22nd postoperative day. The remaining four patients underwent operative treatment on the seventh or eighth postoperative day. All of the operations for chylothorax were successful, and chest tubes were removed promptly. These results show that operative management of chylothorax was reliable and safe. The "one-week trial," however, offered few advantages in determining the therapeutic strategy for postoperative chylothorax.
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Developments in the specialty of general surgery have never been more important, nor have the opportunities for general surgeons been more exciting, than at the present. Technologic advances and the expansion of basic knowledge of surgical diseases have contributed to this renaissance of the field. ⋯ Education of the student preparing for a nonsurgical career in the fundamental concepts underlying surgical therapy must be kept at the forefront of an undergraduate surgical curriculum. Integration and coordination of graduate surgical education in all of the general surgery-based specialties is an important obligation for the future, as knowledge expands in each specialty and the need for more specialty-specific education becomes apparent.
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This study was done to examine the outcome of cardiopulmonary resuscitation (CPR) in the surgical intensive care unit (SICU) and to identify factors preceding cardiopulmonary arrest that could predict survival. ⋯ Patients in the SICU who survived CPR had a stable or improving clinical course as determined by APS and GCS score, and had not had acute organ failure. Patients who were critically ill with a declining clinical course did not survive after CPR.
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Editorial Comment
Cardiopulmonary resuscitation in the intensive care unit.
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Continuous arteriovenous hemofiltration does not improve survival in a canine model of septic shock.
We examined whether or not continuous arteriovenous hemofiltration (CAVH), in the absence of renal failure, would improve either hemodynamic abnormalities or survival in a canine model of septic shock. ⋯ The results of this study suggest that CAVH would be unlikely to provide benefit to patients with gram-negative septic shock, in the absence of renal failure.