Annals of surgery
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During 1968-1973, 122 patients with 126 arterial injuries were treated. In 94 instances (90 patients), these injuries involved extremities. Systolic blood pressure was below 90 mm Hg upon admission in 55.6% of all patients and 37.7% of those with injuries to arteries of the extremities. ⋯ The high patency rate and lack of evidence of pulmonary embolization suggest that associated venous injuries be repaired routinely. Arterial injuries represent ideal lesions (normal arterial wall with excellent run-in and run-off). Prompt treatment of shock and early, proper management of patients' mechanical disruptions will salvage many lives and most limbs.
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Venous air embolism is a potential complication of many surgical, therapeutic, and diagnostic procedures. Aspiration of air via a catheter placed in the superior vena cava or right atrium or placed in the pulmonary outflow tract and pulled through the right heart chambers had been advocated for the treatment of venous air embolism. In this study, three catheter positions were analyzed to determine which was best for removal of gas after induction of massive venous air embolism in dogs. ⋯ A measured amount of air was injected into the left jugular vein and syringe aspiration of the air was attempted through the catheter. In the group with the catheter in the pulmonary artery, aspiration was continuous while the catheter was withdrawn through the right heart chambers. The amount of air aspirated varied widely among the three catheter positions, and no one catheter position proved superior to the other two.
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The results of surgical treatment of 297 soft tissue sarcomas arising in the lower extremity were critically examined. En bloc wide soft part resection (158 cases) yielded five and ten year survival rates of 63% and 50%. Amputation or major disarticulation (139 cases) gave corresponding survival rates of 45% and 29%. ⋯ Amputation should br resorted to if an adequate margin of resection cannot otherwise be obtained. This decision must be weighted against the high frequency of distant metastases in this disease. Postoperative adjuvant chemotherapy and immunotherapy offer prospects of prevention of this tragic outcome.
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Immunosuppression and temporary skin transplantation in the treatment of massive third degree burns.
A method of burn treatment (immunosuppression and temporary skin transplantation) for patients suffering from massive third degree burns is evaluated. The method is based on the prompt excision of all dead tissue (burn eschar) and immediate closure of the wound by skin grafts. Total wound closure is achieved before bacterial infection or organ failure takes place by carrying out all initial excision and grafting procedures within the first ten days post burn and supplementing the limited amount of autograft with allograft. ⋯ Intensive protein and calorie alimentation are provided, and 0.5% aqueous AgNO3 dressings are used. A swinging febrile illness has been associated with large areas of allograft rejection. Eleven children have been treated and seven have been returned to normal, productive schooling.
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Infection is a major complication of military chest injuries. In a series of 142 wounded, infectious complications occurred in 7 (4.9%). Factors influencing the incidence of infection are evaluated. ⋯ Thoraco-abdominal injuries were treated separately. The clotted hemothorax was immediately evacuated. Prolonged antibiotic therapy was usually indicated.