Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Feb 1981
Effects of naloxone therapy on hemodynamics and metabolism following a superlethal dosage of Escherichia coli endotoxin in dogs.
Experiments were done upon anesthetized and unanesthetized dogs given endotoxin only, endotoxin plus naloxone or naloxone only. Dogs given endotoxin and treated with naloxone showed marked hemodynamic and metabolic improvements compared with the dogs given endotoxin only. Beneficial effects of naloxone treatment following the administration of endotoxin are attentuated hypotension, hemoconcentration and acidosis and prevention of hypoglycemia. Results of mortality studies in unanesthetized dogs given endotoxin suggest that naloxone treatment increases the survival time.
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Surg Gynecol Obstet · Jan 1981
The management of transpharyngeal gunshot wounds to the cervical spine.
Management to prevent cervical osteomyelitis in transpharyngeal gunshot wounds which involve the cervical spine consists of triple endoscopy to identify the pharyngeal injury, anteroposterior and lateral view roentgenograms to localize the injury to the cervical spine, administration of penicillin and gentamicin intravenously, exploration of the neck and repair of pharyngeal wounds, debridement of the cervical spine and external immobilization of the spine for six weeks. This management protocol has proved successful in five patients.
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Surg Gynecol Obstet · Oct 1980
Comparative StudyEffect of intravenously administered fluid on hemodynamic change and respiratory function in extensive thermal injury.
In 53 extensively burned patients, a comparative study was conducted on lactated Ringer's solution, colloid plus lactated Ringer's solution and hypertonic lactated saline solution on their hemodynamic and respiratory effects. The total amount of infusion required to resucitate the initial hypovolemic phase was the least in the hypertonic lactated saline solution group; whereas, the total sodium intake was the greatest in the lactated Ringer's solution group. ⋯ Arteriovenous oxygen content difference increased in the hypertonic lactated saline solution group and decreased in the colloid plus lactaed Ringer's solution group, with no significant change in the lactated Ringer's solution group. From this study, the use of hypetonic lactated saline solution seems to be the best choice in the initial resuscitation of thermal injury.
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Accidental hypothermia, a core temperature below 34 degrees C., is frequently fatal, particularly in the ill and elderly. Traditional treatment methods result in reported mortalities of between 45 and 100 per cent. Despite these terrible statistics, advocates of slow rewarming persist. ⋯ Agressive fluid resuscitation, rapid immersion rewarming and careful systematic monitoring have been used to treat ten consecutive patients without a single death. Concomitant problems of alcoholism, stroke, myxedema, tuberculosis and paraplegia were also treated. Rapid external rewarming by immersion can result in a low mortality in patients with severe hypothermia.
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Surg Gynecol Obstet · Jul 1980
The use of cyclosporin A and prednisone in cadaver kidney transplantation.
Eighteen patients were treated with primary cadaveric renal transplantation using cyclosporin A therapy, and four more patients undersent cadaveric retransplantation. Eleven of the 22 recipients were conditioned with lymphoid depletion before transplantation, using thoracic duct drainage or lymphapheresis for two to eight and one-half weeks. Cyclosporin A was begun a few hours before grafting. ⋯ Steroid therapy greatly amplified the value of cyclosporin A. Unless major delayed morbidity develops which is not obvious so far, this drug combination should permit revolutionary advances in the transplantation of all organs. Other adjuncts to the cyclosporin A-steroid combination, including lymphoid depletion techniques, will require further investigation.