Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · May 1989
Metabolism of D lactate in patients receiving hypertonic sodium lactate solution.
The use of hypertonic saline solutions for resuscitation of patients with a decreased extracellular fluid volume is generating more clinical interest. One of the solutions, hypertonic lactated Ringer's solution (HLS), contains lactate in both the D(-) and L(+) forms. Because humans lack D lactate dehydrogenase, the metabolism of D lactate in patients receiving large amounts of lactate in a clinical setting was examined. ⋯ The volume of distribution was 20 per cent of the body weight. These results demonstrate that D lactate is metabolized rapidly even when given in large amounts to humans during the perioperative period. Whether or not this metabolism occurs during hypoperfusion is not known.
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Surg Gynecol Obstet · Apr 1989
New approach to endotoxic and septic shock by means of polymyxin B immobilized fiber.
Endotoxin shock therapy has not been successfully dealt with pharmacologically. Circulation of endotoxins in the blood is an important factor in the pathogenesis and clinical symptoms of endotoxic shock. We have recently developed polymyxin immobilized fiber (PMX-F) as a biomaterial for selectively detoxifying endotoxins. ⋯ Two of the five dogs are still alive. One of the remaining two survived for seven days and the other, 14. We found that PMX-F treatment prolonged or increased the survival rate in the endotoxic and septic dogs.
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Surg Gynecol Obstet · Dec 1988
ReviewDissecting aortic aneurysm in pregnant women without Marfan disease.
Dissection of the young women without Marfan disease is related, in most instances, to pregnancy. The structural changes in the arterial wall that occur during pregnancy may predispose women to this complication of pregnancy. ⋯ In the second patient, diagnosis of dissection and severe aortic regurgitation occurred in the postpartum period. Knowledge of this albeit relatively rare complication of pregnancy may assist the clinician in diagnosing and referring patients early for surgical treatment that, in most instances, may save the lives of both mother and fetus.
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Surg Gynecol Obstet · Nov 1988
Surveillance for postoperative myocardial infarction after noncardiac operations.
Patients with postoperative myocardial infarction are frequently asymptomatic. Several follow-up strategies have been used to detect infarction or ischemia in asymptomatic patients. Different investigators have used quite different criteria to define patients at high risk. ⋯ Several criteria for defining a high risk population were evaluated, including type of operation, age, history of cardiac disease, Goldman's cardiac risk classification and the results of the preoperative ECG. Monitoring of patients with an abnormal preoperative ECG would have identified 88 per cent of the patients with postoperative myocardial infarction and 63 per cent of the patients with definite ischemia. Goldman's risk class identified patients with a normal ECG who were at higher risk for postoperative ischemia.