Southern medical journal
-
Southern medical journal · Oct 1985
Continuous epidural anesthesia for elective cesarean hysterectomy.
Continuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 12 1/2-year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating conditions. Careful patient selection and preparation, expertise in administering continuous epidural anesthesia, and understanding of the demands of the operative procedure are essential when planning epidural anesthesia for cesarean hysterectomy.
-
Southern medical journal · Oct 1985
Case ReportsDiverticulitis complicated by candidal pylephlebitis.
A 58-year-old woman had fever, diarrhea, and polymicrobial bacteremia that progressively worsened despite appropriate antibiotic therapy. At autopsy, a diverticular abscess and pylephlebitis were found, both demonstrating hyphal forms consistent with Candida on microscopy.
-
Growth and maturation in the delivery of prehospital emergency medical care has been dramatic in the past 15 years. The increased availability and use of emergency medical services (EMS) has led to more frequent interactions between providers of prehospital care and the medical practitioner. ⋯ Also presented are the basics of emergency scene and victim stabilization. Physicians can help improve prehospital care by becoming familiar with local EMS capabilities and personnel.
-
We have described a patient in whom tracheal rupture occurred during prolonged mechanical ventilation. Appropriate intensive respiratory care management, including the use of the minimal leak technique, was used. Our patient unfortunately had nearly every known predisposing factor for tracheal damage.
-
Southern medical journal · Jul 1985
Case ReportsAdult respiratory distress syndrome due to malignant histiocytosis.
While a 23-year-old man was being evaluated for a two-month history of night sweats, fever, and weight loss, he had the typical clinical, radiologic, and laboratory findings of adult respiratory distress syndrome (ARDS). After a diagnosis of malignant histiocytosis (MH) was established by lymph node biopsy, review of an earlier lung biopsy initially interpreted as nonspecific revealed malignant histiocytes. He failed to respond to combination chemotherapy and died as a result of progressive respiratory failure.