Arch Surg Chicago
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The problem of postsplenectomy sepsis in adults with traumatic asplenia was reviewed and discussed. Alternatives to splenectomy should be considered when feasible, and pnemococcal vaccination and prophylactic antibiotics are necessary when splenectomy is unavoidable.
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We studied 32 consecutive cases of small-bowel perforations treated in a single surgical unit during the last three years. Clinical features are typical and diagnosis is not difficult. ⋯ There were two deaths in the 16 patients who had exteriorization of the suture line (12.5%), compared with seven deaths in the group of 16 patients who did not have exteriorization (43.75%). Exteriorization of the suture line (16 cases) is a superior method of treatment and significantly lowers the mortality.
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Postoperative outcomes of 31 afebrile patients who had responded to treatment for intra-abdominal sepsis were compared based on the presence or absence of leukocytosis (WBC count greater than 10,000/cu mm) at the conclusion of antibiotic therapy. In 68% of the patients who had leukocytosis, postoperative septic complications developed within two months of their operation. In patients without leukocytosis, complications developed in only 8.3%. Afebrile patients who exhibit leukocytosis but have responded clinically to treatment are at risk for postoperative infection and multisystem failure.
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A grass inflorescence (flowering head) aspirated by a child is difficult to diagnose, and frequently cannot be retrieved by bronchoscopy. Of four pediatric patients with aspirated grass inflorescences, two had severe hemoptysis and the other two were septic at the time of diagnosis. Their chronic debilitation and bronchiectasis necessitated an eventual pulmonary resection, with full recovery in all four patients.
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Twelve adult surgical patients recovering from acute respiratory failure (ARF) had a catheter inserted for measurement of pulmonary capillary wedge pressure, pulmonary artery pressure, and cardiac output; and for calculation of arterial-mixed venous oxygen content difference, physiologic shunt, and systemic and pulmonary vascular resistances. Measurements were made with 5 cm H2O continuous positive airway pressure (CPAP), during spontaneous respiration at ambient airway pressure, and then again with 5 cm H2O CPAP. ⋯ This improvement in oxygenation took place without any significant change in cardiovascular status. Thus, low levels of CPAP are helpful in maintaining the pulmonary status in intubated adult patients recovering from ARF.