Arch Surg Chicago
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Case Reports
Diagnosis and control of posttraumatic pelvic hemorrhage. Transcatheter angiographic embolization techniques.
Fourteen patients with posttraumatic pelvic hemorrhage underwent therapeutic transcatheter embolization of bleeding vessels. Six of them were victims of blunt trauma, six had penetrating trauma, and two had iatrogenic hemorrhage. Eleven patients had a celiotomy prior to angiographic embolization, and large retroperitoneal hematomas were evident in nine patients. ⋯ Two patients died because of traumatic injuries. There were no complications directly associated with the embolization procedures. Transcatheter embolization is a safe, effective method for controlling pelvic hemorrhage in patients with unstable or multiple pelvic fractures whose conditions fail to respond to more conventional forms of therapy.
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Comparative Study
Effectiveness of modified steroid-antibiotic therapies for lethal sepsis in the dog.
Dogs permanently recover (survive at least seven days) from lethal doses of Escherichia coli when treated early with intravenous (IV) intermittent infusions of methylprednisolone sodium succinate and gentamicin sulfate. We evaluated the therapeutic effectiveness of constant or bolus IV infusion of methylprednisolone combined with gentamicin or netilmicin sulfate. ⋯ Gentamicin or netilmicin administration was begun when all organisms had been infused. The probability of recovery from shock was significantly increased when dogs were treated with constant infusion of methylprednisolone and intermittent infusions of gentamicin or netilmicin, but was only moderately increased when treated with intermittent bolus infusions of methylprednisolone and intermittent infusions of gentamicin.
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Twenty hernias of incarcerated fat at the inferior lumbar space were seen during a 23-year period. The usual complaint was a painful mass that caused a backache. The condition was more common in women and girls than in men (18 v two). ⋯ Nineteen of the 20 hernias were treated with surgical excision and repair of the lumbodorsal fascial defect. Results of treatment were good. Though rare, hernias of the inferior lumbar space should be considered when back pain is present, particularly in a young, athletic woman.
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Computed tomographic (CT) scanning accurately can identify and localize deeply embedded wooden foreign bodies in an extremity. Previously, wooden foreign bodies were often difficult to find for surgical removal. ⋯ The accurate description by CT facilitated a precisely planned removal of these foreign bodies without adjacent tissue damage. This new diagnostic tool is valuable for finding obscure low-density foreign bodies in an extremity.
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Clinical Trial Controlled Clinical Trial
Efficacy of hetastarch in the resuscitation of patients with multisystem trauma and shock.
A prospective trial of 6% hetastarch (HES) v 5% plasma protein fraction (PPF) as the colloid component of intravenous (IV) fluid resuscitation was conducted in 32 patients with multisystem trauma and/or hemorrhagic shock. Patient age, mechanism and pattern of injury, and IV fluid requirements were similar in both groups. ⋯ Although this investigation should be viewed as a pilot study, our results suggest that, compared with PPF, HES in large volumes is a safe, effective colloid solution in the resuscitation of patients with multisystem trauma and/or hemorrhagic shock. Further study of HES in a larger number of patients is warranted by these findings.