Surgery, gynecology & obstetrics
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Fluid balance data in 30 severely burned children hydrated according to a fluid resuscitation program were reviewed. The formula to estimate fluid requirements is based upon body surface area and surface area burned rather than weight. It uses two independent figures to estimate maintenance fluid needs and fluid requirements as a result of the burn. ⋯ A maximal weight increase following resuscitation averaged 4 kilograms per square meter of body surface burned. The volumes of urine that can be expected from patients similarly resuscitated have been defined. This program is safe, accurate and effective for a wide range of burn sizes and age groups.
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Surg Gynecol Obstet · Jan 1980
Comparative StudyGastrin and gastric acid secretion in hepaticojejunostomy Roux-en-Y.
Reports on increased duodenal ulceration after bile diversion prompted the present investigation of gastric acid secretion and gastrin in 16 patients with a Roux-en-Y hepaticojejunostomy and 11 patients with a choledochoduodenostomy. Basal and pentagastrin stimulated acid output, gastrin in serum and gastrin in the antral mucosa were all significantly elevated in patients with a Roux-en-Y compared with those patients having a choledochoduodenostomy. In patients with a Roux-en-Y, bile bypassed the duodenum and the most proximal part of the jejunum; it is hypothesized that the bypass of bile may induce gastric acid hypersecretion secondary to an altered biosynthesis and release of gastrin.
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Results of a study of 15 patients with penetrating wounds of the buttock managed during a recent five year period suggest that penetrating trauma to the buttock is a distinct injury syndrome accompanied by serious intestinal, bladder or vascular damage. Following a complete history, physical examination and appropriate roentgenograms, most injuries can be anticipated, but proctoscopy and cystography should be performed upon all patients at risk. Intravenous pyelography, a poor test of bladder integrity, may be misleading and should by supplemented by additional techniques. If a retroperitoneal or intraperitoneal injury is suspected, preoperative antibiotic therapy, followed promptly by aggressive intraoperative management of all injuries, is recommended.