Arch Surg Chicago
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The Boston Center for Liver Transplantation has accumulated one of the larger series of liver allograft recipients. This review has provided an opportunity to examine recent pronouncements by Medicare regarding patient selection and survival and to question whether the current allocation scheme best utilizes a scarce supply of donor liver allografts. ⋯ This center's experience reflects a more realistic expectation of patient survival because it considers the high-risk recipient by diagnosis and urgency status. This study also suggests that assessment of outcome should be a component of allocation planning in the future.
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Case Reports
Is cardiopulmonary bypass effective for treatment of hypothermic arrest due to drowning or exposure?
Various techniques have been advocated for resuscitation from hypothermic arrest caused by ice-cold freshwater drowning or exposure. We have resuscitated five such patients after emergency hospital admission using cardiopulmonary bypass initiated via median sternotomy. All patients presented to our facility with core temperatures less than 26 degrees C. ⋯ All were rewarmed on bypass to 37 degrees C and all survived at least 24 hours. Three of the five patients are currently alive and well with normal neurologic function. Cardiopulmonary bypass is an effective technique for resuscitation after hypothermic arrest due to near drowning and/or exposure.
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Randomized Controlled Trial Clinical Trial
Intraoperative wound infiltration with bupivacaine in patients undergoing elective cholecystectomy.
In a double-blind randomized trial, 50 patients scheduled for elective cholecystectomy received 50 mL of either 0.25% bupivacaine hydrochloride or physiologic saline by wound perfusion at the end of the operation before wound closure. The duration of incisional infiltration, total amount of postoperative analgesics administered, and total hospital stay were recorded. Pulmonary function tests were performed the day before surgery and 1 day after surgery. ⋯ Both groups also had similar decrements in forced vital capacity and forced expiratory volume on the first postoperative day. We conclude that wound infiltration with 0.25% bupivacaine after elective cholecystectomy is not effective in reducing postoperative pain. Lung function disturbances cannot be prevented.
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Skin grafts can be used effectively to inhibit wound contraction. A critical element of this inhibition is the adherence of the graft to the wound bed. Fibrin glue has been shown to increase the adherence of skin grafts to wound beds. ⋯ Graft sites treated with fibrin glue contracted less than the controls from the ninth postgraft day to the completion of the study. The mechanism by which fibrin glue inhibits wound contraction may be related to increased adherence of grafts to the underlying wound bed. As an adjunct in skin grafting, fibrin glue may offer certain advantages that are not achieved by suturing alone.