Surgery, gynecology & obstetrics
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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.
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Records of 102 patients with gunshot and stab wounds to the chest but with normal roentgenogram of the chest upon admission were reviewed. There were no delayed hemothoraces or pneumothoraces. ⋯ A significant number of routine studies were done with an extremely low yield. These patients need not be admitted to the hospital unless there is some other compelling clinical factor.
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Surg Gynecol Obstet · Jun 1981
The importance of the anterior thoracic nerves in modified radical mastectomy.
The medial anterior thoracic nerve supplies the pectoralis minor muscle and costal portion of the pectoralis major muscle. The lateral anterior thoracic nerve supplies the clavicular head and separately, three muscle groups of the sternal head. ⋯ Muscle atrophy of the various groups of muscle bundles may not be apparent for as long as one year after the operation. These observations may be of some importance in the plastic reconstruction after modified radical mastectomy.
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Surg Gynecol Obstet · Apr 1981
Effects of fluid resuscitation on total fluid loss following thermal injury.
Plasma volume loss, cardiac output and hematocrit values have been measured in anesthetized dogs receiving a 15 per cent total body surface area third degree flame burn before and two, four and six hours postburn. One group of dogs received no fluid resuscitation. Five groups of dogs received fluid resuscitation with varying percentages of albumin added to the Ringer's lactate solution. ⋯ The amount of change of these variables was also related to the percentage of albumin in the resuscitation fluid. The greatest improvement in these variables was observed in that group of dogs receiving the greatest percentage of albumin in the resuscitation fluid. These results demonstrate that the administration of resuscitation fluid improves cardiovascular function following thermal injury and that the amount of improvement is related to the percentage of albumin present in fluid used for resuscitation.
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Surg Gynecol Obstet · Mar 1981
Plasma catecholamine levels in the diagnosis and management of pheochromocytoma.
Plasma catecholamine levels have been determined before, during and after operation in seven consecutive patients operated upon for pheochromocytoma. The method used permits the simultaneous determination of norepinephrine, epinephrine and dopamine. All patients had increased levels of one or several catecholamines while hypertensive. ⋯ The present method may prove to be of value as a simple method to ascertain or exclude pheochromocytoma. During operation plasma norepinephrine and epinephrine levels increased up to 600fold when the tumor was manipulated. The unpredictable rapid and large variations in levels of catecholamines found during operation suggest preoperative alpha-adrenergic receptor blockade and monitoring of central circulation.