Surgery, gynecology & obstetrics
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A ten years' experience with this particular shunt has demonstrated that the patency rate, incidence of encephalopathy and of rebleeding and perioperative mortality have remained quite favorable when compared with other shunting procedures. Based upon a ten years' experience, we have no reservations in recommending it as the procedure of choice for patients with alcoholic or posthepatitic cirrhosis who are classified as A, B or C, according to Child's criteria.
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Cricothyroidotomies were performed upon 147 patients at the New York University Medical Center and Booth Memorial Center from March 1976 through February 1978. Cricothyroidotomy was demonstrated to be a rapid and technically simple and precise procedure. The incidence of complications was 8.6 per cent. ⋯ Cricothyroidotomy was performed following prolonged endotracheal intubation in these two patients who had airway obstruction immediately following endotracheal extubation. In both patients, there was a glottic and subglottic component to the laryngeal stenosis suggesting that endotracheal intubation as well cricothyroidotomy played a critical part in the development of laryngeal stenosis. In view of these observations, we believe that cricothyroidotomy is useful, particularly in emergency situations and in patients with median sternotomy incisions but is contraindicated in patients having endotracheal intubation of more than seven days' duration or in patients having airway obstruction develop following removal of an endotracheal tube except as a temporary lifesaving procedure.
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Studies to determine the relationship between increased vascular permeability, water content and protein leakage, and burn size were performed on rats. Partial thickness scald burn covering 10, 20, 30 and 40 per cent of the rats' body surface area were induced in four groups of rats. A fifth group of rats served as the controls. ⋯ While the size of the burn appears to have some influence on capillary permeability, burns up to 40 per cent of the body surface have only a mild and transient effect upon capillaries distant to the site of injury. This observation supports the concept of a humoral mediator for capillary permeability and suggests that more pronounced changes can occur with larger burns. Nonetheless, extravasation of albumin appears to be short-lived.
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Surg Gynecol Obstet · Apr 1979
Case ReportsNonoperative management of intrahepatic hemorrhage and hematoma following blunt trauma.
Four patients with blunt abdominal trauma did not have surgical treatment for intrahepatic hemorrhage and hematoma. Two patients were diagnosed 24 hours after injury as having significant active hemorrhage, although their clinical status was stable. ⋯ Although more patients will have to be evaluated, it is our belief that nonoperative management of selected patients with an intrahepatic hematoma is reasonable and safe. Patients should be observed periodically with radioisotope scans, ultrasound or computerized tomography until the hematoma resolves.
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Surg Gynecol Obstet · Apr 1979
Percutaneous cannulation of the internal jugular vein in infants and children.
A technique for percutaneous catheterization of the internal jugular vein in infants and children was used since January 1975 in 206 patients ranging in age from a few hours to 12 years old. The series included 31 premature infants weighing less than 2,500 grams and 107 babies weighing less than 4,000 grams. Five attempts at cannulation failed. ⋯ The 22 late complications were related to infection; one infant died because of catheter sepsis. To minimize septic complications, an arbitrary limit of seven days was set, after which the catheter was replaced. Cannulation of the internal jugular vein in infants and children should be regarded as a serious surgical procedure to be performed by a trained team and only when properly indicated.