Surgery, gynecology & obstetrics
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The availability of ultrasonography and computerized tomography has significantly improved diagnostic capability in the evaluation of splenic abscess. In addition, recent evidence has shown that percutaneous drainage of splenic abscess is a safe and efficacious approach to therapy and is indicated especially when patients are seriously ill, postoperative or when the risks of general anesthesia, surgical drainage or splenectomy are substantial. ⋯ Discussion of important features of this illness, as well as a comprehensive review of reported instances and guidelines related to percutaneous drainage of splenic abscess, are presented herein. A team approach, which uses the experience of imaging and surgical personnel, is invaluable in therapy when a splenic abscess is encountered.
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Surg Gynecol Obstet · Sep 1988
Comparative StudyUse of the multiple uptake gated acquisition scan for the preoperative assessment of cardiac risk.
A retrospective study was undertaken at three hospitals of 196 patients who underwent an operative procedure as long as 60 days after radionuclide determination (multiple uptake gated acquisition scan [MUGA]) of left ventricular ejection fraction (LVEF). Cardiac related mortality rates were 2.2 per cent among patients in group 1, LVEF greater than or equal to 55 per cent; 5.4 per cent in group 2, LVEF 36 to 54 per cent, and 19.5 per cent in group 3, LVEF less than or equal to 35 per cent (p less than 0.005). Statistically significant correlation between MUGA-derived LVEF and cardiac related mortality was found in veteran patients undergoing noncardiac surgical procedures (both vascular and nonvascular). ⋯ A preoperative American Society of Anesthesiologists Physical Status Evaluation classification of IV or a preoperative pulmonary capillary wedge pressure of 20 centimeters of water or greater also predicted an increased risk of postoperative cardiac death. We advise preoperative MUGA scans for all patients in whom the results of preoperative history or physical examination suggest compromised ventricular function. We also advise pulmonary arterial catheter hemodynamic monitoring during the perioperative period for all patients with a preoperative MUGA-derived LVEF of less than or equal to 35 per cent.
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Surg Gynecol Obstet · Sep 1988
A simple technique for redirection of malpositioned Broviac or Hickman catheters.
A simple angiographic technique for repositioning an aberrantly located Broviac or Hickman catheter tip is described. It is easy to perform and requires catheters and guide wires that are available in all angiography rooms. The technique is effective, and it has had no complications.
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Surg Gynecol Obstet · Aug 1988
Comparative StudyComparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients.
Long term venous access devices have become an important part of the standard care for children with malignant diseases requiring chemotherapy. A prospective nonrandomized study was conducted between January 1985 and January 1987 examining complications, child and parental acceptance and costs between totally implantable venous access devices (ports) and externally exiting catheters. Fifty ports were placed in 49 patients who had a median age of ten years; median implant time was 350 days. ⋯ There were 15 infectious complications with catheters compared with seven with ports (p less than 0.01). Child and parental acceptance questionnaires indicated that the ports were easier to care for and more readily accepted in children older than 11 years than were catheters (p less than 0.001). Totally implanted reservoirs are effective alternatives to external catheters for venous access in children with cancer.
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Surg Gynecol Obstet · May 1988
Fasciotomy for severe, blunt and penetrating trauma of the extremity.
Blunt or penetrating injuries to the extremity with vascular or severe soft tissue and skeletal trauma frequently require fasciotomy. Long term follow-up studies of these patients are rare. From 1976 to 1983, 85 patients underwent 39 fasciotomies upon the upper extremities and 57 upon the lower. ⋯ Seven of the patients interviewed were unemployed due to the injuries they received to the extremities. Most symptoms were believed to be due to the severity of the injury, and none were directly attributed to the fasciotomy. When fasciotomy is indicated, it is a safe adjunctive procedure in limb salvage and contributes very little to the long term morbidity of patients with severe trauma to the extremity.