Annals of surgery
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This paper examines the role of neurologic impairment as an indication for CT examination of the abdomen in children after blunt trauma. The clinical information and abdominal CT examinations of 482 consecutive children were reviewed prospectively for indications for abdominal CT and presence and severity of abdominal and chest injury. Children were divided into two groups determined by Glasgow Coma Scale (GCS): GCS less than 8, and greater than or equal to 8. ⋯ Three neurologically impaired children required abdominal surgery (3.3%) vs. 14 of 369 (3.8%) children with a GCS greater than or equal to 8; p = NS). We conclude that children with severe neurologic impairment are at higher risk for intraabdominal injury than those without coma, but that neurologic impairment without abdominal signs is a low-yield indication for abdominal CT examination. Abdominal CT scan should be reserved for children in whom there is a high clinical index of suspicion of significant abdominal trauma based on physical examination and the mechanism of injury.
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A 10-year review of 101 patients sustaining an early postoperative small bowel obstruction within 30 days of celiotomy was carried out. Signs, symptoms, lab tests, and x-rays did not indicate which patients required operation. Twenty-three patients were operated on for either failure to resolve their obstruction or because it was feared that ischemic bowel was present. ⋯ Early postoperative small bowel obstruction was most often due to adhesions and inflammatory processes. Seven patients died (6.9%), three in the operated and four in the nonoperated group. Because ischemic bowel is very unlikely in patients with early postoperative small bowel obstruction, we advise 10 to 14 days of nasogastric suction initially; after this, improvement is unlikely without reoperation.
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During a 5-year period, 22 patients with obstructing carcinoma of the left colon were operated on in our department. All patients underwent emergency subtotal colectomy with primary ileocolonic or ileorectal anastomosis. The quality of life for patients undergoing subtotal colectomy is excellent. ⋯ During a followup period of 65 months, four patients died from spread of their primary disease while two other patients died of unrelated causes. Sixteen patients are alive and free of disease. We consider subtotal colectomy the procedure of choice for patients with obstructing carcinoma of the left colon.
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Thermal injury is associated with dysfunction of host defense systems. The present study used flow cytometric immunofluorescence analyses to investigate changes in number and phenotype of lymphocytes in seven different lymphoid compartments at 2, 6, 12, 24, 48, and 60 days after 50% total body-surface area thermal injury in the rat. Relative to sham-injured control rats, at postburn day 2, significant lymphopenia was observed in the peripheral blood along with depletion of lymphocytes from the spleen and thymus. ⋯ The second phase then ensued with significant phenotypic changes again occurring in most tissues from days 24 to 60 after injury. These studies demonstrate that burn injury results in dramatic alterations in lymphocyte numbers and subset percentages in different lymphoid compartments. Immune alterations observed following thermal injury may be due, in part, to a redistribution of the cellular elements responsible for generation of the immune response.
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To evaluate the effect of blood conservation in cardiac surgery, use of blood products was analyzed in patients undergoing CABG before and after implementation of blood conservation techniques. Age, sex, coronary anatomy, ejection fraction, cardiopulmonary bypass time, and the preoperative hematocrit, platelet count, and clotting studies were similar in both groups. Methods of blood conservation included autologous transfusion of blood withdrawn before bypass, autotransfusion of shed mediastinal blood, strict protocols for transfusion, and acceptance of normovolemic anemia. ⋯ The postoperative hematocrit was significantly lower and remained so at discharge. However, 30 days later there was no difference. This reduction in transfusion requirements decreased costs and donor exposure.