Annals of surgery
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Comparative Study
Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state.
Fifty-six blunt multiple trauma patients (HTI-ISS 22-57) were studied for the effects of immediate versus delayed internal fixation of a femur or acetabular fracture on the pulmonary failure septic state. The pulmonary failure septic state may be defined as an alveolar arterial oxygen tension difference greater than 100, plus fever and leukocytosis. These patients were divided into four groups. ⋯ Thirty days of femur traction increased the duration of the pulmonary failure septic state relative to Group I by a factor of 3 to 5 for all criteria at a statistically significant level, while increasing fracture complications by a factor of 17, positive blood cultures by a factor of 74, and the use of narcotics by a factor of 2. Group IV, which had four out of seven immediate internal fixations, behaved similarly to Group II. Femoral shaft traction should be avoided in the blunt multiple trauma patients because it greatly increases the cost of care and the risk of multiple systems organ failure.(ABSTRACT TRUNCATED AT 400 WORDS)
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Clinical parameters, intensive care unit (ICU) course, abdominal computed tomography (CT) scans, and the clinical decisions of 53 critically ill patients were reviewed to determine the influence of the CT scan. No scans were positive before the eighth day. Sensitivity was 48% and specificity, 64%. ⋯ Hospital charges were +33,408. Personnel time and cost were 497 hours and +3658; of the total +37,066, 77% (+28,541) could be considered wasted. From these data, it was concluded that CT scans should be used to confirm abscesses, not to search for a source of sepsis.
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Sequential changes in circulating total protein and albumin masses after abdominal vascular surgery.
Sequential changes in total circulating protein (TCP) and total circulating albumin (TCA) masses after different blood replacement regimens were investigated in a prospective study involving 40 patients undergoing reconstructive abdominal aortic surgery. Group I (13 patients) had 80 gm of albumin during operation and 60 gm of albumin during the following 3 days. Blood loss was replaced milliliter for milliliter by whole blood. ⋯ In groups II and III, a significant decrease in TCP was followed by complete recovery of TCP. This also entailed a decrease in the TCA/TCP ratio, indicating an enhanced synthesis of acute-phase proteins. Based on these findings, a depression of globulin synthesis by supplemental albumin administration is proposed.
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Between 1960 and 1980, 137 patients with colonic volvulus (52% cecal, 3% transverse colon, 2% splenic flexure, and 43% sigmoid) were seen at the Mayo Clinic. Among the 59 patients with sigmoid volvulus, four (7%) had colonic infarction. Total mortality with sigmoid volvulus was seven per cent. ⋯ Total mortality for cecal volvulus patients was 17%. Mortality for all forms of volvulus in patients with viable colons was 11%. Mortality for all patients with volvulus was 14%.
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Comparative Study
Extracellular fluid deficit following operation and its correction with Ringer's lactate. A reassessment.
The changes in extracellular fluid volume (ECV) in two groups of surgical patients, one receiving Ringer's lactate solution intraoperatively and the other receiving only dextrose and water, were assessed. A deficit in the ECV, as measured by radioactive sulfate, of 1.9 +/- 0.8 l (p less than 0.003) compared to the preoperative volume was found in the dextrose group. ⋯ The use of intraoperative Ringer's lactate (1660 cc +/- 96 cc) resulted in no change in the ECV, an increase in the mean creatinine clearance (+10% p less than 0.05), and no change in sodium excretion or tracer clearance. As a result of these findings, it appears that postoperative sodium retention is a physiologic response to a decreased ECV, which can be prevented by the administration of Ringer's lactate.