Arch Surg Chicago
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Surgery for breast cancer continues to evolve. Less radical procedures and increasing concern about appearance and rehabilitation are now the trend. ⋯ Fifty immediate reconstructions of the breast after modified radical mastectomy were performed in 48 women with carcinoma of the breast. We believe this procedure greatly enhances rehabilitation and quality of life without diminishing the ability to diagnose or treat recurrent disease.
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Hemorrhagic shock plus resuscitation leads to expansion of both interstitial fluid space (IFS) and intracellular fluid (ICF). THe IFS expansion is thought to reflect reduced serum colloid oncotic pressure (COP) from capillary leak of serum albumin (SA). This hypothesis was analyzed in 138 injured patients who received an average of 13.6 units of blood and 10.7 L of saline solution for correction of shock. ⋯ The fall in the PV-ECF ratio during the postresuscitation fluid sequestration phas is associated with but not due to reduced TIAC and COP, both of which remained low after the PV-ECF ratio has normalized during the mobilization phase. Contrary to prior reports, albumin leak is not responsible for reduced COP, TIAC, and postresuscitation weight gain. Presumably, the low COP results from decreased reentry of albumin into the plasma volume due to entrapment within the IFS matrix.