Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Dec 1978
Transcatheter embolization of autologous clot in the management of bleeding associated with fractures of the pelvis.
Extraperitoneal hemorrhage, associated with a fracture of the pelvis, is a major cause of death in pedestrian accidents. Transfusion alone may be unsatisfactory. Direct control of bleeding may be required. ⋯ Transcatheter embolization of autologous clot was used to control hemorrhage in three patients with such a fracture. If laparotomy is required immediately, arteriography of the pelvic area may be done postoperatively, If laparotomy is not performed, arteriography may define pelvic bleeding sites. Transcatheter embolization of autologous clot controls hemorrhage from branches of the hypogastric artery.
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Definition of the appropriate therapeutic goals for physiologic monitoring of patients postoperatively was approached by analyzing more than 50,000 values of the 20 most commonly monitored variables in a series of 113 critically ill patients throughout their immediate postoperative course. In general, normal values were poor criteria for monitoring, since normal values were restored in an average of 75 per cent of the survivors and 76 per cent of the nonsurvivors for the five most frequently measured variables; that is, arterial pressure, heart rate, central venous pressure, wedge pressure and cardiac output. ⋯ The empirically determined median value of the survivors taken in the late stage during periods remote from therapy was found to be a better criterion for therapeutic goals for most variables, including blood flow, oxygen transport and most intravascular pressures. However, normal values were satisfactory for arterial pressure, peripheral resistance, pH, mixed venous oxygen tension and arterial carbon dioxide tension, largely because of the biphasic patterns of these variables.
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Surg Gynecol Obstet · Dec 1978
Results of surgical treatment of carcinoma of the lung by stage and cell type.
The results of surgical treatment in 470 patients with carcinoma of the lung were analyzed by stage of disease and by histologic cell type. The need for accurate staging in selecting treatment and in prognosis for survival is emphasized. Surgical resection improved survival time in all categories of patients by effective local control of the lesion. ⋯ The highest five year survival rate was 43 per cent and was observed in resected Stage I carcinomas. Only 29 per cent of this group died of the disease and 28 per cent, of other causes. The continued high incidence of death due to distant metastases underlines the necessity of combining operation with other forms of treatment.
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The understanding of the basic principles governing current flow through the body is necessary for the safe application of electrosurgical technique. They also may provide a guide to the design of laboratory studies which are needed to understand completely the ubiquitous nature of radiofrequency current distribution in surgical procedures.
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Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in those patients placed in the lithotomy position undergoing gynecologic operations, the burn being on the buttocks, and in those undergoing orthopedic operations, the burn being on the extremities and under a tourniquet. ⋯ To prevent these burns from occurring, the skin must not be abraded excessively before the final skin preparation solution is applied; the agent should not be allowed to pool and become trapped under the tourniquet or the torso of the patient, and the agent should be allowed to dry before the patient is draped. In our experience, the agent that has been the most effective and the least irritating to the skin during the time it has been used is povidone-iodine.