Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Feb 1990
Review Case ReportsObstruction of the neonatal airway from teratomas.
Most neonates with cervical or oral-pharyngeal teratomas have airway obstruction and an obvious mass. In previous reports, obstruction of the airway had caused 49 deaths in 164 newborns with cervical teratomas and five deaths in 24 newborns with oral-pharyngeal teratomas. ⋯ Three infants with cervical teratomas, one infant with an oral-pharyngeal teratoma and one with a combined cervical and oral-pharyngeal teratoma were born in Phoenix over a one year period of time, and all had airway obstruction. These five patients demonstrated the value of prenatal planning and prompt postnatal surgical care by an ultrasonographer, a perinatologist, a neonatologist, maternal and pediatric anesthesiologists and a pediatric surgeon.
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Surg Gynecol Obstet · Feb 1990
Review Historical ArticlePrinciples of management of shotgun wounds.
As an instrument of close range combat, the shotgun has no parallel. At short distances, its destructive capacity parallels that seen from high velocity missile injury. In this study, the history of the shotgun, wound ballistics, principles of initial therapy and special management problems related to shotgun wounds of specific sites are reviewed. ⋯ A subset of patients who do not require abdominal exploration exists. Specific problems encountered in defining this subset are enumerated. Three algorithms are presented that summarize our current management approach to shotgun wounds of the torso and extremities.
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Surg Gynecol Obstet · Feb 1990
The thumb and index finger as principal surgical instruments to secure the inferior vena cava between the liver and the diaphragm in routine operations of the liver.
Presented herein is a simple and safe technique to secure the IVC in its segments above the liver and below the diaphragm through a simple incision in the abdomen. After complete division of the hepatic ligaments, the index finger is passed through the upper recessus of the lesser sac, behind the vein, and just above the caudate lobe, meeting the right thumb on the right side of the vein. A tissue string is then passed, and the IVC is secured. The experience of the authors with more than 100 consecutive hepatectomies has shown this technique to be a reliable approach to secure the IVC during routine hepatic operations.
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Surg Gynecol Obstet · Feb 1990
Comparative StudyTreatment of uncontrolled hemorrhagic shock with hypertonic saline solution.
Hypertonic saline solution (HTS) treatment of uncontrolled hemorrhagic shock (UCHS) induced by incision of three major branches of the ileocolic artery, leading to free intra-abdominal bleeding, was studied in rats. The rats were divided into two groups. In group 1, the abdominal wall was closed immediately after induction of hemorrhage and the rats were divided into six subgroups--1a, five untreated; 1b, 14 treated with 5 milliliters per kilogram of sodium chloride 7.5 per cent (HTS) after five minutes; 1c, eight had HTS infused after 15 minutes; 1d, nine had HTS infused after 30 minutes; 1e, nine had HTS infused after 60 minutes, and 1f, nine had HTS infused after 120 minutes. ⋯ In group 2, the hemodynamic response to intra-abdominal vessel injury in untreated rats was similar to that of those in group 1 and the amount of sponges used to absorb shed blood was 2.4. After five, 60 and 120 minutes of HTS treatment, the hemodynamic response was similar to that in group 1. Five and one-half (p less than 0.01), 3.5 and 3.0 sponges, respectively, were used to absorb shed blood.(ABSTRACT TRUNCATED AT 400 WORDS)