Surgery, gynecology & obstetrics
-
Spontaneous pneumoperitoneum may pose a diagnostic dilemma, especially when evaluating a patient who has no or minimal abdominal or constitutional findings accompanying its presence. The free intraperitoneal air may be the result of a perforation of a hollow viscus in such instances. Under these circumstances, the air is most often from another source. ⋯ Diagnostic and therapeutic procedures in or adjacent to the abdomen may result in an iatrogenic pneumoperitoneum. In each instance when the findings of an acute abdominal catastrophe are lacking, the circumstances present before the discovery of the pneumoperitoneum should give a clue to the appropriate diagnosis. When a reasonable nonsurgical cause can be discerned, continued observation may be sufficient, thus avoiding an unnecessary laparotomy.
-
Surg Gynecol Obstet · Mar 1982
Clinical Trial Controlled Clinical TrialEpidurally administered morphine for postcesarean analgesia.
A double blind study was performed to evaluate analgesia from epidurally injected morphine sulfate in 30 mothers after cesarean section following similar regional anesthetics. When compared with a saline placebo and 2 milligrams of epidurally injected morphine, a 4.5 milligram epidurally administered morphine dose resulted in a highly significant reduction in the initial 24 hour parenterally administered narcotic requirement, p less than 0.001, and a significantly greater duration of analgesia after epidural injection, p less than 0.0003. ⋯ No significant side-effects were noted. Epidurally administered morphine appears promising as a potent analgesic approach of extended duration with potential advantages for early maternal mobilization, improved fetal maternal interaction and reduced fetal narcotic exposure in the breast fed infant.
-
Twenty-two instances of diaphragmatic rupture secondary to blunt thoracoabdominal trauma were seen at the Trauma Unit of the Health Sciences Centre, Winnipeg, Manitoba, Canada during a 30 year period. Diaphragmatic laceration occurred in the right leaf in 11, in the left in ten, and in both sides in one instance. In 14, the diagnosis was made and repair effected within 24 hours of presentation. ⋯ The diagnosis of diaphragmatic disruption should be considered in any patient suffering from blunt thoracoabdominal trauma. Usually a roentgenogram of the chest will confirm the suspected injury. In contradistinction to most of the reported series, our experience indicates that right diaphragmatic injuries are more common than what is usually thought.
-
Peritoneal lavage has become widely accepted in the management of blunt abdominal trauma, but its role has not been clearly established in the evaluation of penetrating abdominal injuries. The interpretation of lavage effluent analysis and the criterion for laparotomy are also unclear. A review of our recent experience and that of other indicates that peritoneal lavage has a significant role in detecting intra-abdominal injury from abdominal stab wounds and penetrating injuries of the lower part of the chest. ⋯ It is of negligible value in the evaluation of penetrating trauma to the back and flank. Quantitation of erythrocytes in the lavage effluent is the most reliable indication of intra-abdominal injury, and the level of significance varies according to the mechanism and location of the injury. The usefulness of other analysis of the effluent remains undetermined.