Int Surg
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Operative stabilization of massive chest wall instability is described in 38 patients. 35 patients were young combat casualties with penetrating chest injuries operated upon at front hospitals with limited resources, two patients sustained automobile accidents with blunt thoracic trauma resulting in an extensive flial chest and one patient with elective chest wall resection for soft tissue sarcoma. Intramedullary K-Wires were universally used as costosynthetic stabilizers. The results were classified as good to excellent in comparison to non operative or other complex operative procedures and a very low mortality rate was achieved as compared to our past experience and the surgical literature.
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This prospective study was designed to test the hypothesis that intraoperative hypothermia occurring during abdominal aortic surgery and vasodilator therapy used to avoid severe consequences of aortic clamping could both disturb the mixed venous oxygen saturation signal (SVO2). Twenty high risk surgical patients, ASA physical status II or III, were catheterized with the standard pulmonary artery catheter; SVO2 was determined by direct spectrophotometric measurements of oxygen haemoglobin concentration of serial samples. The relationships between SVO2, haemodynamic, metabolic variables and core temperature were analyzed. ⋯ Intraoperative hypothermia provided an increased haemoglobin affinity for oxygen. Vasodilator therapy which allowed a decrease in systemic vascular resistance produced an increase in the left-right shunt and in venous oxygen admission. Thus hypothermia and vasodilator therapy could be both responsible for the elevated SVO2 occurring during infrarenal abdominal aortic surgery.