Surgery, gynecology & obstetrics
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The incidence of serious burn injuries has been determined for the Commonwealth of Virginia during a 21 month period. The data set included all patients with burn injuries who entered the hospital and were considered to be in serious enough condition to require treatment in a hospital. ⋯ Examination of the date revealed large differences in the magnitude of age-specific incidence rates between men and women and the white and nonwhite population. Differences in the economic status of the population may explain a large proportion of the variation in the crude burn rates.
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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.
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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.
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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.
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Carcinoma of the colon and rectum metastasizes readily to the ovaries, and oophorectomy during operation upon the colon and rectum remains an effective surgical technique for precluding subsequent oophorectomy and, thereby, diminishing the morbidity of carcinoma of the colon and rectum in women. This procedure does not significantly affect the survival rate. Carcinoma of the ovary has become the fourth most common lethal cancer in women. ⋯ The five year survival rate remains about 30 per cent. The incidence of carcinoma of the ovary in women with carcinoma of the colon and rectum is roughly five times the incidence of carcinoma of the ovary, that would be expected by chance. We believe the aforementioned observations strongly expand and reinforce the original proponents of prophylactic oophorectomy performed upon women with carcinoma of the colon and rectum and that, therefore, oophorectomy should be an integral part of operation upon the colon and rectum in women.