Surgery, gynecology & obstetrics
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Since a controversy exists over whether patients with truncal shotgun wounds should have selective or mandatory exploration, we reviewed the records of 1,222 patients with truncal missle wounds treated over a six year period at our institution. Based upon a detailed review of 42 of these patients, who had sustained shotgun wounds, we believe that not all patients with truncal shotgun wounds require mandatory surgical exploration. That, in fact, a subgroup of patients can be identified who can be safely managed nonoperatively, based upon the pattern of the injury and the clinical status of the patient at the time of arrival to the emergency room.
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Head injury is a significant economic, social and medical problem in the United States. For this reason, prognostic factors in head injury are of major importance to all surgeons who treat severely injured patients. Outcome of severe head injury is frequently determined at the time of impact, and surgical and medical treatment is often ineffective. ⋯ Multimodality evoked responses are a noninvasive prognostic technique which predicts outcome with a high degree of certainty. For optimal accuracy, prognosis should be based upon a combination of factors, including age, Glasgow coma score, pupillary response, eye movements, presence of surgical lesion, motor posturing and multimodality evoked responses. Decisions regarding surgical and medical treatment of patients with head injury should be based upon these prognostic factors.
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Surg Gynecol Obstet · Nov 1984
Comparative Study Clinical TrialCrystalloid versus colloid resuscitation in experimental hemorrhagic pancreatitis.
In a canine model of acute hemorrhagic pancreatitis, crystalloid resuscitation with a balanced salt solution adequately restored plasma volume, supported tissue perfusion and prevented excessive hemodilution without detrimental effects on pulmonary pressures or oxygenation. No advantages in using colloid resuscitation were apparent in our study.
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Surg Gynecol Obstet · Sep 1984
Randomized Controlled Trial Clinical TrialImprovement in amino acid use in the critically ill patient with parenteral formulas enriched with branched chain amino acids.
To assess the value of BCAA enriched solutions in patients under stress, we studied five critically ill, intensive care unit patients requiring total parenteral nutrition. Two complete feeding solutions were compared: one containing 15.6 per cent of the amino acids as BCAA and the other enriched to contain 50 per cent as BCAA. These solutions were prepared to be isocaloric and isonitrogenous and were administered in consecutive 24 hour periods. ⋯ Plasma leucine, isoleucine and valine concentrations were also significantly increased with administration of the BCAA enriched solution, whereas plasma levels of glycine, tyrosine and phenylalanine were significantly reduced. These changes represent a normalization of plasma amino acid levels with administration of BCAA enriched solution. In addition, the improved net leucine balance observed during administration of BCAA suggests patients have an improved protein balance while receiving BCAA enriched solutions.
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Surg Gynecol Obstet · Sep 1984
Comparative StudyComparison of analgesic activity of buprenorphine hydrochloride and morphine in patients with moderate to severe pain postoperatively.
Since buprenorphine has been reported to be effectively analgesic yet free of addiction potential, two single-dose, double-blind, parallel studies were conducted to compare its analgesic activity and safety with those of morphine. The patients in each study consisted of patients experiencing moderate to severe postoperative pain. ⋯ The degree of sedation, vital signs and side effects were evaluated. Buprenorphine generally appeared comparable to morphine in the onset and duration of action and in side effect liability.