Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Feb 1987
Comparative StudySerum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction.
To better define the serum osmolar and compositional changes associated with the infusion of a large volume of hypertonic saline solution (sodium of 250 milliequivalents per liter), we compared resuscitation using a hypertonic crystalloid (HSL) to Ringer's lactate (RL) in 52 patients undergoing aortic reconstruction. There were no differences between the groups in any of the preoperative measurements, the duration of operation, operative blood loss or transfusion requirement. The RL group required 9.5 liters of fluid intraoperatively as compared with 6.3 liters required by the HSL group (p less than 0.01). ⋯ HSL is safe and effective for use in the resuscitation of moderate blood volume deficit. Changes in serum sodium values and in osmolarity resolve rapidly. The serum potassium level should be monitored closely and replaced aggressively.
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Surg Gynecol Obstet · Jan 1987
Skin microvascular permeability after resuscitation with Ringer's lactate solution from endotoxin shock.
Skin microvascular membrane permeability was assessed in anesthetized dogs after resuscitation from endotoxin shock. Infusion of Ringer's lactate solution, in a volume equal to 7 per cent of the body weight, reversed hypotension produced by an intravenous injection of Escherichia coli endotoxin (0.5 milligrams per kilogram). The shock group was compared with a group of dogs not given endotoxin and infused with a similar dose of Ringer's lactate solution and a with control group of dogs. ⋯ The wet to dry tissue weight ratio of skin samples did not increase in the endotoxin group. Skin microvascular membrane permeability did not increase. The safety factors that helped to prevent edema after infusion of Ringer's lactate solution included an increase in lymph flow and sieving by the intact microvascular membrane which diluted the interstitial protein concentration.
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Surg Gynecol Obstet · Sep 1986
Comparative StudyComparison of isotonic and hypertonic fluids in resuscitation from hypovolemic shock.
Hypertonic electrolyte solutions provide effective fluids for resuscitation of burn patients and concurrent replacement of hemorrhage. Infusion of mannitol has also been advocated as a means of increasing cardiac output in acutely ill patients. ⋯ RL and HSL restored and maintained cardiac output more effectively than HMR. At 24 hours, HSL maintained blood pressure most effectively.
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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.