Minerva chirurgica
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Comparative Study
[Totally implantable venous access systems. Analysis of complications].
Totally implantable central venous access devices (Port-a-Cath, PaC) allow better treatment of cancer patients, with safe administration of chemotherapeutic agents, and are well accepted by the patients. The aim of the present paper is to analyze the complications of the different implant techniques on the basis of a personal experience of 92 central venous access devices. ⋯ On the basis of the personal experience we think that PaC are of easy implant, with few complications and of good acceptance from the patients. We prefer venous cutdown on cephalic vein as implant technique because of avoidance of pnx or bleeding complications. Percutaneous puncture of subclavian vein is useful for implantation during major surgery, because less time consuming, and in case of anatomical anomalies fo the cephalic vein. Basilic vein cutdown has been utilized exclusively for esthetic reason in young people, to avoid the scar in the upper thoracic region. Alternative implant techniques has been employed in special conditions, such as catheter position in the inferior v.cava, or early in our experience (internal jugular vein). A total of 7 complication have been reported (7.6%), 4 sepsis and 3 mechanical (2 dislodgement, 1 rotation). Sepsis were not related to implant technique, presenting on day 29, 45, 64 and 401 respectively; all required the explant of the PaC as a treatment. Mechanical complications are related to surgical technique; all required re-exploration with 1 explant and 2 reposition of the PaC. In PaC positioning during surgery for primary cancer (8 cases) no morbidity has been reported. All but the 5 PaC explanted were functioning until patient's need; maximum length reported is 42 months.
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Comparative Study
[Spontaneous and traumatic pneumomediastinum. Analysis of 34 cases].
Pneumomediastinum (spontaneous, iatrogenic and traumatic) is a relatively uncommon infrequently reported entity. The most common cause is the rupture of marginal pulmonary alveoli, allowing bubbles of air to dissect along the vascular sheaths and connective tissue planes to the mediastinum. Rupture of the trachea or thoracic traumas are other causes of pneumomediastinum. ⋯ Physical finding revealed: subcutaneous emphysema extended to face, chest or neck, and Hamman's sign. Chest X-ray was made in all cases and diagnosis was completed with chest CT scan and tracheoscopy. We present our series of 34 PM between January 1.1993 to July 31.1995 and discuss about etiology, diagnosis and treatment of this entity.
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Comparative Study
[Hypertonic saline solutions in resuscitation in hemorrhagic shock. An experimental study].
The aim of the study was to evaluate the use of hypertonic solutions in restoring intravascular volume in a model of hemorrhagic shock. Eighteen pigs underwent general anesthesia and were instrumented with a carotid catheter to record mean arterial pressure (MAP), a pulmonary artery catheter for pulmonary arterial pressure (MPAP) and cardiac output (CO) monitoring and an electromagnetic flowmeter around the abdominal supraceliac aorta for aortic flow measurement (Vaor). Oxygen delivery (DO2) and oxygen consumption (VO2) data were calculated by standard formulas. ⋯ During the two hours follow-up only the animals reinfused with HSDX maintained hemodynamic and oxygen transport values at normal levels. We conclude that the administration of hypertonic saline solutions during hemorrhagic shock allows the saving of infusion volumes, thus diminishing the occurrence of interstitial edema formation. The adding of dextran to the solution prolongs the hemodynamic effects.
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Since the first true herniorrhaphy was performed by Bassini 100 years ago, all modifications and surgical techniques have shared a common disadvantages--suture line tension. This is the prime etiologic factor behind hernia recurrence. By using modern prosthetics mesh, it is now possible to repair all hernias without distortion of normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective; allowing prompt resumption of unrestricted physical activity.
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Review Case Reports
[Hemolysis and multiple trauma. A clinical case report].
A patient is described who presented hemolysis after a chest and head trauma. We checked out every possible cause of anemia and our conclusion is that trauma itself was the cause of hemolysis. As an explanation, we suggest that red blood cells were broken in lung capillaries because of endothelial damage due to pulmonary injury.