Southern medical journal
-
In this series, nine pregnant patients had appendectomy. Seven patients had acute appendicitis; pyuria and symptoms suggesting urinary tract infection delayed diagnosis in one whose appendix perforated. Abdominal pain and nausea with or without vomiting were presenting symptoms in all of the patients. ⋯ There were five maternal deaths, all in the group of patients with perforation. Perinatal mortality was 4.8% among patients with acute inflammation only and 19.4% in those with perforative appendicitis. The diagnosis rests on clinical acumen, and prompt surgical intervention is the key to good outcome.
-
Southern medical journal · Dec 1991
Comparative Study Clinical Trial Controlled Clinical TrialAnalgesia after thoracotomy in children: a comparison of interpleural, epidural, and intravenous analgesia.
The cohort for this study included 39 patients, between the ages of 8 and 20 years, who had had thoracotomy. Postoperative analgesia was provided by one of three techniques: intravenous narcotics (20 patients), thoracic epidural catheter (10 patients), or interpleural analgesia (IPA) (nine patients). Both IPA and epidural analgesia were administered according to a specific protocol. ⋯ Four of 10 patients in the epidural group and two of nine in the IPA group required no interventions during the initial 72-hour postoperative course. In the epidural analgesia group, there were 19 days (of a total of 30 days) during which patients required no interventions. This percentage was significantly greater (P less than .05) than that of the IPA group, in which there were 9 days (of a total of 27 days), during which no interventions were required.
-
Trauma is the fifth leading cause of death for the elderly. Approximately 7.4 million (3% of the population) are more than 80 years old (the so-called "old" old). More than 40% of Americans will reach the age of 80 years, and those who do can expect to live an average of 8 years more. ⋯ In this age group, even small burns can be problems, and indications for hospital admission should be broadened. The advanced elderly also cause financial burdens to burn centers because of inadequate diagnosis-related group (DRG) reimbursement. For those surviving, there is a good chance for maintaining independent function and for being discharged home.
-
We have reported a case of severe frostbite due to direct exposure to liquid Freon gas (monochlorodifluoromethane), a fluorinated hydrocarbon widely used as refrigerants, propellants, and industrial solvents. The patient was treated for severe third- and fourth-degree frostbite to the hand. The severity of the injury was apparently the result of direct through-and-through injury from exposure to the liquid (boiling point -40.5 degrees C) and a possible systemic vasoconstrictive effect on arterial smooth muscle due to inhalation of Freon gas.
-
Southern medical journal · Sep 1991
Case ReportsAortoiliac dissection after percutaneous insertion of an intra-aortic balloon pump.
Aortic or aortoiliac dissection may complicate percutaneous intra-aortic balloon pump insertion in various ways. Thrombosis can escape clinical recognition if no major obstruction develops. Death due to perforation after dissection is not uncommon. In this case study, aortoiliac dissection led to bilateral iliac artery stenosis, an unusual complication of percutaneous femoral cannulation for insertion of a balloon pump.