Annals of surgery
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Influenced by continuing improvement in results from Stanford, cardiac transplantation was resumed at the University Health Center of Pittsburgh in June 1980. Cyclosporin A (CyA) became available to the authors early in 1981. This report describes the preliminary experience with 21 patients who were treated between March 1981 and April 10, 1982 with cyclosporin A and low-dose steroids. ⋯ No late death has occurred because of rejection, and a unique feature is that three recipients with a lymphocytotoxic mismatch did not develop hyperacute rejection. The number of infectious episodes and nonviral infections appears to be less than that associated with the use of azathiaprine and larger doses of steroids. Cyclosporin A (5-10 mg/kg/d) and low-dose prednisone (rapidly tapered in seven days from 200 mg to 15-20 mg/d) is effective in preventing early morbid rejection of the transplanted heart.
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Comparative Study
Carotid endarterectomy under regional (conductive) anesthesia.
Carotid endarterectomy is reliable in the prevention of strokes due to arteriosclerotic disease at the carotid bifurcation. This is a retrospective review of 314 carotid endarterectomies performed at the University Health Center of Pittsburgh. The objectives of the study were to determine if regional anesthesia was a safe technique for carotid endarterectomy and to determine whether the neurologic complications that occurred were embolic or ischemic in origin. ⋯ Further more, the incidence of non-neurologic complications under general anesthesia was 12.9%. Under regional anesthesia, the incidence of non-neurologic complications was 2.8%. The data supports carotid endarterectomy under regional block as safe and reliable method.
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Ninety-two patients with American Burkitt's lymphoma were studied retrospectively to elucidate the role of surgery in the complications of treatment of Burkitt's lymphoma. All of the patients reviewed had been treated with at least one chemotherapeutic agent. Seventy-five percent of the patients had predominantly abdominal disease that required a laparotomy for diagnosis and treatment when possible. ⋯ Surgery was necessary in five patients with life-threatening pericardial effusion. Other surgical treatments are also reviewed. It is concluded that Burkitt's lymphoma has a significant cure rate with the appropriate medical and surgical therapies, and that the surgical approach to the disease and its complication should be optimistic and appropriately aggressive.
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A quadrant scheme is presented for estimating postoperative fluid volumes for replacement of internal fluid shifts (third space losses) in pediatric surgical patients undergoing major intraabdominal surgery. The benefits derived from using a prescribed postoperative fluid management program that includes this quadrant scheme are determined by analyzing a series of 50 consecutive patients managed by five senior general and thoracic surgical house officers. Although the program tended to overestimate the fluid needs of the patients relative to a predetermined optimal urine output level, all but two patients with septic complications were hemodynamically stable and none had complications due to the fluid administration program.
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Thirty-eight patients with locally recurrent soft-tissue sarcomas of various histologic types and grades but with no evidence of distant metastases were studied. Twenty-five patients had more than one local recurrence. Most primary lesions had been initially treated by simple or "wide local" excision with removal of little or no surrounding normal tissue. ⋯ Amputation for control of local recurrence was necessary in only three patients. the remaining patients underwent either resection alone or resection in combination with postoperative radiation and/or chemotherapy. Life-table analysis of these 38 patients shows an unexpectedly high predicted five-year survival of 76% (87% for patients whose local recurrence could be completely resected). This high salvage rate clearly justifies aggressive treatment of patients with local recurrences alone and warrants attempts to salvage functional extremities.