Surgery, gynecology & obstetrics
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Recent immigration trends have resulted in an increased prevalence of amebic hepatic abscesses in southern states and in many northern American cities. Because amebic hepatic abscesses generally do not require drainage, differentiation from pyogenic hepatic abscesses is important. We, therefore, reviewed the records of patients admitted to the UCLA Medical Center from 1968 through 1983 to compare the clinical manifestations and to access the results of treatment of pyogenic and amebic hepatic abscesses. ⋯ Over-all, the mortality was 40 per cent for patients with pyogenic abscesses whereas all 40 of the patients with an amebic abscess survived. However, operative mortality was only 4.5 per cent for the 22 patients with pyogenic abscess who were managed with systemic antibiotics and surgical drainage. We conclude that many clinical and laboratory parameters can aid in the differentiation and, as a result, management of patients with pyogenic and amebic hepatic abscesses.
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The Adult Respiratory Distress Syndrome remains one of the most lethal complications in both surgical and medical intensive care units. Mortalities of 50 to 80 per cent are still reported in recent reviews. ⋯ Studies of physiopathologic factors of ARDS implicate granulocyte aggregation with the formation of oxygen free radicals and other cellular and chemical mediators. Pharmacologic agents and high frequency positive pressure ventilation are presently being investigated, but the accepted form of therapy combines increased inspired oxygen tensions, positive end expiratory pressure and some form of mechanical ventilation, if necessary.
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Thermal injury sustained during pregnancy presents special management problems for both the gravid woman and her unborn child. Of 6,573 admissions to this burn center during the period of 1950 through 1982, 1,157 (17.6 per cent) were female and 448 (6.8 per cent) were of reproductive age. Thirty of this latter group (6.7 per cent) of burned patients were pregnant at the time of injury. ⋯ If the injury of the gravid patient is lethal, the pregnancy will usually terminate spontaneously prior to her death. Obstetric support and aggressive fetal monitoring is recommended for all moderately and severely burned pregnant patients. Obstetric intervention may be considered in the ill patient with a near term fetus in whom significant complications (such as, hypotension, hypoxemia or sepsis) jeopardize the life of the fetus.
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The choice of fluid for volume replacement in hemorrhagic shock remains controversial. This study was done to compare the cardiac hemodynamic and metabolic effects of several regimens of fluid resuscitation. Thirty nonsplenectomized dogs subjected to two hours of hemorrhagic shock were resuscitated with shed blood alone or in combination with plasma, saline solution or Ringer's lactate solution. ⋯ Furthermore, correction of metabolic acidosis and decreased lactate production were comparable in all groups. During late resuscitation (180 to 200 minutes), cardiac hemodynamic and myocardial efficiency were significantly lower in the shed blood, plasma and saline solution groups. Our data show that Ringer's lactate solution is singularly effective in maintaining left ventricular performance despite similar preload, coronary blood flow and myocardial oxygen delivery after all regimens of volume replacement.
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Surg Gynecol Obstet · Apr 1985
Critical factors in determining mortality from abdominal aortic trauma.
Aortic injuries remain highly lethal. Major factors contributing to death in these patients appear to be free peritoneal hemorrhage and associated abdominal vascular trauma. These conditions often manifest as profound shock upon hospital presentation and portend a grim prognosis. Potential means to improve survival include: 1, vigorous resuscitation and prompt operative intervention in patients with penetrating abdominal trauma presenting in a state of shock; 2, careful search and control of associated vascular injuries prior to definitive aortic repair, and 3, constant vigilance to coagulation function, core temperature and acid-base status.