Arch Surg Chicago
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Twenty-three patients who sustained either blunt or penetrating thoracic trauma underwent early decortication after failure of chest tube drainage. Patients were divided into two groups: (1) ten with isolated chest injuries were compared with (2) 13 with chest trauma and other associated major injuries. ⋯ Group 2 patients had later decortications (19.3 days), higher incidence of infected clot, yet were home in 9.8 days after thoracotomy. Early decortication is advocated as a safe and expedient means of dealing with the complications of traumatic pneumothorax and hemothorax.
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A tracheoesophageal fistula secondard to prolonged nasogastric intubation and ventilatory assistance via a cuffed tracheostomy tube developed in a 27-year-old woman who had sustained a traumatic injury. The fistula grew progressively larger despite removal of the tubes, thus demonstrating the inherent poor prognosis associated with the untreated lesion. Since the cuff necessarily damages the trachea circumferentially at the same level, closure of the fistula and circumferential excision and reconstruction of the damaged tracheal wall were performed with an excellent result up to four years after the repair. This would be the preferred procedure when the patient can be weaned off the respirator and when the general condition and the size of the fistula allow such a definitive one-stage approach.
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Clinical Trial Controlled Clinical Trial
Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients.
Cardiac output and pulmonary wedge pressure (PWP) were used to evaluate the end point of fluid resuscitation in 20 patients suffering from multiple trauma and shock. Eleven patients received crystalloid resuscitation and nine patients received colloid resuscitation. Fifteen of 20 patients had an adequate cardiac output at the termination of resuscitation, but but only six of these patients had a PWP above 10 mm Hg. ⋯ Five patients did not achieve adequate cardiac output and four of these patients died, suggesting that cardiac output was the most important criterion for adequate resuscitation. If the goal of fluid resuscitation is to achieve an adequate cardiac output, then PWP was not a reliable guide. Furthermore, using both cardiac output and PWP as a guide to fluid resuscitation of our patients, we found that the type of fluid (crystalloid or colloid) for resuscitation did not influence the course of respiratory distress in these patients up to three days following resuscitation.
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Comparative Study
Inguinal herniorrhaphy under local anesthesia. A prospective study of 100 consecutive patients with emphasis of perioperative morbidity and patient acceptance.
For various reasons, repair of inguinal hernias under local anesthesia is not well accepted. The purpose of this study is to evaluate the effectiveness of local anesthesia in inguinal hernia repairs. One hundred consecutive inguinal herniorrhaphies are reported. ⋯ Patient acceptance and their immediate postoperative course are also described. The study demonstrates that inguinal hernias can be easily repaired under local anesthesia, complications are minimal, and patient acceptance, excellent. We strongly recommend thath this form of anesthesia be used in the "routine" repair of inguinal hernias in cooperative patients.