Surgery, gynecology & obstetrics
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All 150 psychiatric consultations performed upon patients hospitalized on the Surgery service at The Johns Hopkins Hospital during a period of two years were studied with particular attention to delirium which was found in 20.7 per cent of the patients. Delirium was the most common psychosis in elderly and postoperative patients. Mood disturbance was the most common reason given for request for psychiatric consultation (39.3 per cent). ⋯ Delirium is a common syndrome and presents as altered consciousness with cognitive impairment. It is often not appreciated by the surgeon because of the impressive nature of associated symptoms which might be given undue emphasis. Assessment of consciousness and cognitive function should be performed promptly whenever psychiatric disorders are suspected.
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Surg Gynecol Obstet · Aug 1986
Interneural and intervascular extension for increased exposure in midline vertical incisions.
In instances in which wide upper lateral abdominal exposure is required, standard midline incisions are occasionally inadequate. The typical invered "U" incision violates the nerve and blood supply to the abdominal wall. An interneural and intervascular incision which is used either as an extension of the midline incision or bilaterally as the primary incision is described herein. ⋯ This extension raises a triangular flap of abdominal wall with a base on the costal cartilage and apex at the junction of the two incisions. In a series of seven patients, no interneural and intervascular incision resulted in wound hernia or delayed wound healing postoperatively. This approach provides superior lateral abdominal exposure and by paralleling nerve and vascular distribution, follows sound anatomic principles for minimizing pain and promoting subsequent wound healing.