Arch Surg Chicago
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Intermittent mandatory ventilation allows a gradual transition from mechanical ventilation to spontaneous breathing. This is accomplished by providing a continuous source of fresh gas from which the patient can breathe as ventilator rates are decreased from 1 to 2 per minute. Monitoring of arterial blood gas tension values documents the safety of further withdrawal of ventilatory support. Many patients are more easily and safely weaned by this method than by conventional techniques.
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Profound hypercalcemia associated with immobilization is rare. Hypercalcemic crisis occurring as a result of immobilization in which there was not a coexisting, contributing medical condition has not, to our knowledge, been reported previously. ⋯ Review of previously reported cases emphasizes the difficulty in recognition and diagnosis of this unusual condition. Surgeons treating patients with fractures should be aware of this complication and familiar with its appropriate therapy.
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Subtrochanteric fractures of the femur comprise only 5% to 7% of hip fractures, but are important because of the difficulty in management. They combine the problem of instability to varus deformation common to comminuted intertrochanteric fractures and the problem of delayed union common to diaphysial fractures of the femur. ⋯ Improved results have been obtained by utilizing a fixation device that can control the intertrochanteric instability and that has sufficient strength to withstand deforming forces that may be present for up to a year while the fracture is uniting. Bone grafting has been found very useful in shortening the overall period of healing.