Surgery, gynecology & obstetrics
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Stab wounds of the chest may be associated with a spectrum of injuries ranging from the lethal to the insignificant. The management of asymptomatic patients with stab wounds of the chest is controversial. The results of previous reports have asserted that asymptomatic patients with stab wounds of the chest do not have delayed complications develop if roentgenograms of the chest taken six hours after the injury are normal. ⋯ An asymptomatic patient with a stab wound of the chest that is not precordial, not in proximity to the subclavian artery and not suspected of diaphragmatic penetration should be serially examined and have a follow-up roentgenogram of the chest at six hours. If the patient remains asymptomatic and the six hour film is normal, delayed complications are rarely, if ever, encountered and the patient does not require further studies or hospitalization. The six hour rule for stab wounds of the chest is valid.
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Surg Gynecol Obstet · Sep 1989
Percutaneous insertion of subclavian venous catheters in infants and children.
All attempts at subclavian venous catheterization by the Pediatric Surgery Service done during a one and one-half year period at the Children's Hospital of Los Angeles were prospectively studied. Catheterization was attempted in 107 patients with a mean age of 9.8 years. Cannulation of the vein was successful 89 times (71 per cent) with the major complications being arterial puncture (8.0 per cent), pneumothorax (2.4 per cent) and abnormal position (12.8 per cent). ⋯ Percutaneous insertion of subclavian venous catheters can be accomplished in infants and children with low morbidity. Cannulation of the left subclavian vein can be accomplished with a similar success rate and a lower malposition rate than the right side. Fluoroscopy is a useful tool to assist in the correct placement of the catheter.
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Surg Gynecol Obstet · Aug 1989
Randomized Controlled Trial Comparative Study Clinical TrialPresumptive antibiotics for penetrating abdominal wounds.
The optimal antimicrobial agent or agents for penetrating abdominal injuries remains undetermined. During the three year period ending August 1987, 317 consecutive patients undergoing celiotomy for penetrating abdominal trauma were prospectively randomized to receive either mezlocillin, 4 grams every six hours, or clindamycin, 600 milligrams every six hours, and gentamicin, loading dose of 2.0 milligrams per kilogram, then 1.5 kilograms every eight hours. Antibiotics were begun in the emergency department with duration of coverage based on the pattern of injury: the colon, five days; other hollow visceral injury, two days, and all others, one day. ⋯ The offending pathogens were similar. The most common isolates in intra-abdominal abscess were Escherichia coli, Klebsiella and Enterococcus species and anaerobic Bacteroides species. Mezlocillin, an extended spectrum penicillin, achieved similar results, compared with the expensive and potentially toxic combination regimen in patients with penetrating abdominal injuries.
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Surg Gynecol Obstet · Aug 1989
Comparative StudyInfusion of small volume of 7.5 per cent sodium chloride in 6.0 per cent dextran 70 for the treatment of uncontrolled hemorrhagic shock.
The effect of a solution of 7.5 per cent sodium chloride in 6.0 percent dextran 70 was studied in a rat model of uncontrolled hemorrhagic shock induced by partial resection of the tail of the rat. Fifty rats were randomly assorted into five groups of ten rats each. In group 1, uncontrolled hemorrhagic shock was induced by sharp resection of 10 per cent of the terminal portion of the tail of the rat. ⋯ Increased bleeding was followed by a fall in mean arterial pressure in groups 4 and 5 with a 60 per cent mortality rate (p less than 0.01) in both groups and respective, mean survival times of 135 +/- 29 and 144 +/- 26 minutes, which were significantly increased compared with group 1 (p less than 0.01 for both). The intravenous infusion of 6 per cent dextran 70 alone in group 3 resulted in delayed bleeding of 1.23 +/- 0.6 milliliters (p less than 0.04) after 180 minutes. It is concluded that infusions of small volume of 7.5 per cent sodium chloride or 7.5 per cent sodium chloride in 6.0 per cent dextran 70 solutions in rats in a state of uncontrolled hemorrhagic shock led to increased bleeding, decrease in mean arterial pressure and increased mortality.
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Surg Gynecol Obstet · May 1989
Avoidance of injury to the left hepatic duct during parenchymal dissection for hepatic trisegmentectomy.
A simplified and safe technique is described herein for the dissection of the feedback structures to the medial segment of the left lobe, while preserving the integrity of the remaining left hepatic bile duct during the dissection for right hepatic trisegmentectomy. This is accomplished by passing a biliary probe into the main left hepatic duct from the stump of the right hepatic duct. Use of this technique during the performance of a hepatic trisegmentectomy expedites the hepatic dissection and decreases the potential for intraoperative injuries of the remaining bile duct to the lateral segment of the left lobe of the liver. In addition, irrigation of the left hepatic bile duct through the open right duct stump may demonstrate leakages of bile that may be repaired, leading to a decreased over-all morbidity in the subsequent postoperative period.