Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Dec 1993
The effect of heat load and dehydration on hypertonic saline solution treatment of controlled hemorrhagic shock.
Small volume hypertonic saline solution has been suggested for initial effective resuscitation of hemorrhagic shock. The effect of hypertonic saline solution in controlled hemorrhagic shock was studied in rats subjected to dehydration or heat, or both. The rats were randomly divided into four groups--group 1 (n = 19), normal rats; group 2 (n = 21), water deprivation for 12 hours; group 3 (n = 20), heating at 37 degrees C. for five hours, and group 4 (n = 19), water deprivation for 12 hours and heating at 37 degrees C. for five hours. ⋯ This difference in response to HTS remained significant 45 minutes from infusion in groups 3c (p < 0.05) and 4c (p < 0.05), but not in dehydrated rats in group 2c. Arterial bleeding did not alter serum sodium significantly in all four groups. Infusion of HTS in group 1c was followed by an increase in serum sodium from 149.1 +/- 1.4 to 161.1 +/- 2.4 milliequivalent per liter (p < 0.001), while infusion of HTS in group 4c, where serum sodium was initially elevated to 157.1 +/- 3.0 milliequivalent per liter, did not further elevate the serum sodium level.(ABSTRACT TRUNCATED AT 400 WORDS)
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Surg Gynecol Obstet · Nov 1993
Pediatric pelvic fractures combined with an additional skeletal injury is an indicator of significant injury.
Traumatic fractures of the adult pelvic area have high rates of associated injuries and hemorrhagic complications resulting in significant morbidity and mortality. We studied whether or not the plain roentgenographic identification of other fractures is a reliable marker of increased morbidity and mortality in children with pelvic fractures. The records of 79 children admitted with the diagnosis of pelvic fracture from January 1986 through December 1990 were reviewed. ⋯ The RTS was significantly lower (p < 0.05). In children with pelvic fractures, we found that any additional bony fracture is a significant marker for head and abdominal injury. This constellation identifies patients who may benefit from early transfer to a regional pediatric trauma center.
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Surg Gynecol Obstet · Nov 1993
Comparative StudyA review of the results of laparoscopic versus open appendectomy.
Proponents of laparoscopic appendectomy emphasize the advantages of laparoscopic operation--decreased hospitalization, paralytic ileus, postoperative pain and wound complications, including infection. This study compared open laparoscopic appendectomy with laparoscopic appendectomy. To compare the two techniques, patients undergoing laparoscopic appendectomy at four hospitals were compared with patients undergoing open appendectomy during a six month period. ⋯ Patients with acute appendicitis recuperated more quickly from the laparoscopic procedure, as evidenced by the time until eating regular diet, period of hospitalization, incidence of nausea and pain medications on postoperative day one (p < 0.05). The absence of wound infections after laparoscopic appendectomy can be attributed to the practice of placing the appendix in a sterile bag or into the trocar sleeve before removal from the abdomen. Laparoscopic appendectomy reduces the period of hospitalization, postoperative ileus, nausea and postoperative pain in patients with acute appendicitis.(ABSTRACT TRUNCATED AT 400 WORDS)
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Surg Gynecol Obstet · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialBlood loss at time of cesarean section by method of placental removal and exteriorization versus in situ repair of the uterine incision.
The current study was undertaken to determine if blood loss at the time of cesarean section is affected by method of placental removal (spontaneous versus extracted) or uterine position for repair (in situ versus exteriorized). This prospective randomized study involved 100 women who were undergoing a cesarean section. The patients were placed into one of four groups--1, spontaneous placenta detachment, in situ uterine repair; 2, spontaneous placental detachment, exteriorized uterine repair; 3, manual placental removal, in situ uterine repair, and 4, manual placental removal, exteriorized uterine repair. ⋯ Uterine position did not significantly affect blood loss in the spontaneous group (1 and 2; p = 0.971) or the manual placental removal groups (3 and 4; p = 0.061). The hematocrit values for all groups were similar preoperatively, but postoperatively, were significantly lower in the manual removal groups when compared with the spontaneous placental separation groups (p < 0.001). The method of placental removal and not the position of the uterus at the time of its repair has a significant role in blood loss during cesarean birth.
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Displaced sternal fractures cause extensive pain and may impair ventilatory efforts, particularly in the elderly. Most previous reports have focused on repair of sternal fractures using wires. We recommend the technique of plate fixation described herein.