Annals of surgery
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Data from fifty-five patients who had hepatic resections for colorectal liver metastases at the National Cancer Institute (NCI) were analyzed to determine the effect of perioperative blood transfusions on disease recurrence and overall survival. Besides blood transfusions, other factors included in the analysis were size, number, and distribution of metastases, margin status of resected metastases, length of disease-free interval, Duke's stage of the primary tumor, type of hepatic resection, and anesthesia time. Using the Cox proportional hazards model, the amount of blood transfused was found to be a significant prognostic factor. ⋯ The number of resected nodules (1-2 vs. greater than or equal to 3), type of resection (anatomic lobectomy vs. wedge resection), and nodule size (less than or equal to 3.0 cm vs. greater than 3.0 cm) were additional factors that were further evaluated to determine the effect of blood transfusions. Analyses stratified for each of these factors revealed that patients who received greater than or equal to 11 units of blood had a significantly decreased disease-free and overall survival compared with patients who received 3-10 units of blood. It is concluded that the amount of perioperative blood transfused is an independent prognostic factor that adversely effects disease-free and overall survival.
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The clinical significance of hematuria after blunt trauma was studied in 378 consecutive children evaluated by computed tomography (CT) of the abdomen. Clinical and demographic data, as well as indications for CT (such as hematuria, abdominal tenderness, distention, contusions, and abrasions) were recorded prospectively at the time of CT examination. Hematuria was present in 256 children (68%). ⋯ Yet when asymptomatic hematuria was the only indication for CT examination, the risk of any abdominal injury was negligible (0 of 41 patients). The presence and severity of hematuria can be useful markers of underlying abdominal injury only in association with other suggestive clinical signs and symptoms. Asymptomatic hematuria is a low-yield indication for abdominal CT in children with blunt abdominal trauma.
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This report reviews the history of the development of civilian helicopter ambulance program as a component of a total emergency medical services (EMS) system. Current literature demonstrates significant reduction in trauma mortality for those patients transported by air either from the scene of the accident or from an outlying hospital to a trauma center. The primary factor is not the speed of the transport but administration of life-saving care by the helicopter medical crew at the scene of the accident or at the outlying hospital. Regulations have been developed to assure proper patient selection, quality care, safety, and minimization of misuse of this expensive resource.
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Comparative Study
A clinical survey of aortobifemoral bypass using two inherently different graft types.
The performance of knitted Dacron and polytetrafluoroethylene (PTFE) bifurcated grafts are compared in this study of 312 patients at a single institution. Patients of the two graft groups were statistically well-matched in risk factors and degree of distal obstructive disease. Operating time needed to implant either graft was approximately equal. ⋯ Complications affected 13% of the patients of the Dacron group and 4% of the PTFE group. All six graft infections and all seven graft double-limb thromboses occurred in Dacron grafts. Anastomotic aneurysms, amputations, and late graft revisions occurred with greater frequency in patients with Dacron grafts.
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Comparative Study
Significant reductions in mortality for children with burn injuries through the use of prompt eschar excision.
During the past 19 years, mortality due to burn injuries has markedly declined for children at the Boston Unit of the Shriners Burns Institute (SBI), dropping from an average of 9% of SBI admissions during 1968-1970 to an average of 1% during 1981-1986. Detailed statistical analysis using logistic regression was necessary for determining whether this decline in mortality was explained by changes in patient characteristics, such as age or burn size, which are known to strongly influence the outcome of burn injuries. This dramatic decline in mortality during the past 19 years was not the result of change in the age of the patients or their burn sizes; rather, it may be attributed to improvements in burn care. ⋯ Dramatic improvement in survival occurred in patients with burns covering more than 50% of the body surface area. Since 1979, mortality has been essentially eliminated for patients with burn sizes less than 70% of the total body surface area (of 296 patients with burns covering 15-69% of the total body surface area, only two patients died). During the period 1979-1986, 29 of 37 patients (78%) survived an 80% or greater total body surface area thermal injury.