Canadian journal of surgery. Journal canadien de chirurgie
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Ten cases of combined diaphragmatic and hepatic resection for tumours involving both structures are described. A complete work-up, including ultrasonography and computed tomography, usually can predict potential direct spread to the diaphragm. ⋯ Diaphragmatic invasion by primary or secondary tumours does not preclude resection for cure. Pulmonary function studies are not necessary if there is no serious pre-existing lung disease.
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The Biomedicus centrifugal pump was required to provide prolonged ventricular support to 13 patients with hemodynamic instability: 11 after cardiovascular surgical procedures, 1 after myocardial infarction and 1 after failure of a heart transplant. The duration of support ranged from 3.5 hours to 9 days (mean 72 hours). Complications included bleeding in six patients, renal insufficiency in three and central nervous system deficit in three. ⋯ Five patients were discharged from the hospital. There was one death 8 months postoperatively. Prolonged ventricular support with the centrifugal pump may allow recovery of potentially reversible ventricular dysfunction in selected patients after cardiac surgical procedures.
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Historical Article
Surgical research: its importance in the evolution of the specialty of general surgery.
General surgery is a specialty that has gradually been defined by the evolution of surgery in general, the major events being the identification and separation of subspecialties. Advances in knowledge brought about by research have been the major determinants in allowing the development of these subspecialties. Research has played a major role in the redefinition of general surgery, which has now in its own right become both the parent specialty and a subspecialty: the parent specialty because of its continued concern with disease states of a general nature, such as trauma, critical care, nutrition, transplantation, oncology; a subspecialty because of its focus on specific areas of surgery, particularly gastrointestinal surgery. Future developments in general surgery depend on fostering research in both the general and specific areas, and also across the whole spectrum from the most basic to applied clinical research.
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The most important role of dilatation and curettage is in the evacuation of retained products of conception; its diagnostic value is mostly limited to the detection of cancer of the endometrium. The procedure is associated with a number of complications, the majority of which occur during dilatation of the cervix. Vabra curettage is suggested as an alternative to diagnostic dilatation and curettage; it is efficient, is associated with fewer complications and is less expensive. Hysteroscopy is a useful supplement to Vabra curettage, especially in diagnosing focal lesions.
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Because of inadequate rewarming or equilibration of body temperature, patients who undergo cardiac surgery with hypothermia often are still hypothermic after arrival in the intensive care unit. The incidence of residual hypothermia and its hemodynamic effects were assessed in this study. ⋯ Although not statistically significant, there was a trend toward higher systemic vascular resistance in the patients with hypothermia. The authors conclude that mild residual hypothermia is still common after cardiac surgery and may contribute to the depressed hemodynamic status of these patients.