Journal of the American College of Surgeons
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In 1956, Kendrick described a technique for below-knee amputation (BKA) using anterior and posterior flaps in a length ratio of 1:2. There has been no review of the utility and safety of this technique over the past four decades. ⋯ The Kendrick procedure for BKA with anterior and posterior flaps is efficacious and safe. This procedure is advantageous for its anatomic basis, the ease with which the flaps can be designed despite leg edema or overall size, and the ability of the surgeon to distance the posterior flap margin from sepsis in the lower one-third of the calf.
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The American College of Surgeons' Committee on Trauma (ACSCOT) has developed field triage guidelines intended to identify seriously injured patients. Unlike the 1990 version, the 1993 revision calls for on-line medical control assistance with the triage decision for patients whose only marker of severe injury is the mechanism of their injury. We prospectively examined the application of the 1990 ACSCOT field triage guidelines to evaluate Emergency Medical Service (EMS) utilization of these guidelines and the potential effects of the 1993 revision. ⋯ The current ACSCOT field triage guidelines are appropriate when applied by field EMS personnel.
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The feasibility and applicability of using surgeon-controlled robotic arms as a substitute for surgical assistants during urologic laparoscopic surgery was assessed. ⋯ We found that simultaneous use of remote controlled robotic arms as surgical assistants is feasible in genitourinary laparoscopic surgery. The potential long-term cost effectiveness of using robotic surgical assistants in laparoscopic surgery highlights the economic impact of this research and warrants further investigation.
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Randomized Controlled Trial Clinical Trial
Infectious morbidity, operative blood loss, and length of the operative procedure after cesarean delivery by method of placental removal and site of uterine repair.
This study was done to determine the impact of the method of placental removal and the site of uterine repair on postcesarean infectious morbidity rates in women receiving prophylactic antibiotics at cesarean delivery. ⋯ Manual placental removal and exteriorization of the uterus for repair of the surgical incision increases the infectious morbidity rate in women receiving prophylactic antibiotics at the time of cesarean delivery and increases the length of hospitalization.
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Pericardial tamponade caused by central venous catheter perforation of the heart is a catastrophic complication that can be prevented by attention to proper positioning of the catheter tip proximal to the cardiac silhouette. This study was performed to determine awareness of this potential complication among physicians and to suggest measures to minimize the incidence of this problem. ⋯ Pericardial tamponade resulting from central venous catheter perforation of the heart can be avoided by adherence to proper technique in the placement of these catheters, ensuring that the catheter tip lies proximal to the cardiac silhouette, optimally in the superior vena cava, 2 cm proximal to the pericardial reflection. Physicians who place these catheters and train others to do so must be aware of this issue and they must educate their trainees as well. Radiologists responsible for interpreting the roentgenographs of the chest obtained after catheter placement should be alert to catheter malposition and communicate this information promptly. Hospital protocols should deal with this issue explicitly and insist on repositioning of catheters if catheter tips are seen to lodge in suboptimal positions.