Arch Surg Chicago
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Clinical Trial
Heparin-protamine mismatch. A controllable factor in bleeding after open heart surgery.
To test the effect of a new system designed to reduce heparin-protamine mismatch on bleeding after open heart surgery. ⋯ A reduction in protamine dose was associated with significant decreases in blood product use and postoperative bleeding. Excess protamine warrants consideration as both an important and a controllable factor in coagulopathy after open heart surgery.
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To review the outcomes of patients with open pelvic fractures. ⋯ Management of open pelvic fractures requires a well-coordinated group using several techniques. Selected patients with open pelvic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.
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To determine if (1) lubricating starch glove powder contaminates surgical wounds even after powdered gloves have been washed and/or wiped: (2) starch powder can be eliminated from surgical wounds when the surgical team wears only powderless gloves; and (3) starch powder introduced into surgical wounds may increase scar formation. ⋯ Starch powder is introduced into wounds by the use of powdered gloves despite glove washing and wiping. It can be eliminated by the exclusive use of powderless gloves. The inflammatory reaction to starch is variable and can be severe.
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To determine the incidence, severity, and outcomes of injury in patients treated in a rural-based level I trauma center and to compare the outcomes with a nationally indexed patient population--the Major Trauma Outcome Study. ⋯ Acceptable mortality rates compared with the Major Trauma Outcome Study can be achieved in a rural-community-based level I trauma center despite relatively small numbers of critically injured patients. Such outcomes may assist in justifying resource allocation for trauma centers in rural areas.
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Comparative Study
Intravenous contrast medium impairs oxygenation of the pancreas in acute necrotizing pancreatitis in the rat.
Contrast-enhanced computed tomography is widely used to evaluate severe acute necrotizing pancreatitis (ANP) by demonstrating areas of malperfusion, which might indicate irreversible necrosis. Because of our prior finding that the intravenous contrast medium (CM) accentuates the severity of ANP by promoting further necrosis and higher mortality, we sought to investigate the mechanism by which this injury is mediated. ⋯ The prolonged reduction of oxygen saturation of hemoglobin in the pancreas following the administration of intravenous CM in rats with severe ANP indicates that CM impairs the pancreatic microcirculation in necrotizing forms of AP. This may explain our previous finding that CM increases pancreatic injury and mortality in rodents with ANP, and it underlines our concern that the use of contrast-enhanced computed tomography early in human AP may promote the evolution of pancreatic necrosis.