Canadian journal of surgery. Journal canadien de chirurgie
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Tisseel (Immuno AG, Vienna, Austria), a fibrin sealant, adhesive and hemostatic agent made up of sterilized human and bovine components, was used in hypospadias repairs. The incidence of fistula and significant edema and the duration of hospitalization were all reduced in 30 patients who underwent modified Mustardé repairs in which Tisseel was used when compared with a matched group of 30 repairs without Tisseel. In addition, the rate of complications in fistula repairs and complex revisions was reduced when Tisseel was used on urethral suture lines and under all skin flaps.
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Small-volume resuscitation with hypertonic saline is an attractive modality but is still at an early stage of experimental and clinical investigation. Aggressive resuscitation from traumatic, hypovolemic shock could be facilitated during the prehospital phase, but hypotension remains a physiological and beneficial compensatory mechanism to minimize active bleeding until definitive care is provided. Despite encouraging results, the author concludes that, at present, hypertonic saline cannot be considered a truly "magic potion" for resuscitation of the trauma patient.
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Emergency airway management in the patient with blunt trauma is a clinical dilemma. Many of these patients require immediate airway management, but each method carries its own set of risks and benefits. ⋯ In this article, the issues surrounding selection of an appropriate technique for airway management are reviewed critically. Recommendations are made for management of the airway in this high-risk group of patients with injury to the cervical spine.
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Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving surgical outcome.
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An unusual case of a recurrent, postoperative, small-bowel obstruction is presented. The obstruction was due to a phytobezoar proximal to the site of a primary carcinoid of the small bowel. ⋯ The cause of the recurrent obstruction was likely a "ball-valve" effect of the phytobezoar at the site of stenosis caused by the carcinoid. This case emphasizes the value of small-bowel imaging in repeated small-bowel obstruction.