Surgery, gynecology & obstetrics
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In a series of 75 patients review for injuries of the gastrointestinal tract, a consistent degree of hypokalemia and hypofibrinogenemia was noted. The degree of hypokalemia was associated with the severity of trauma and subsequent mortality. The degree of hypofibrinogenemia was associated more with mortality than with severity of trauma.
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The records of 31 patients with carcinoma of the proximal bile ducts were reviewed and the operative procedures, results, causes of deaths and autopsy findings were analyzed and correlated. Ten poor risk patients were treated by external drainage and died of jaundice or abscesses of the liver within six months. However, one patient survived 13 months after effective bilateral drainage. ⋯ A patient who underwent resection of the common hepatic duct and hepaticoduodenostomy died of ascending cholangitis nine months postoperatively, while a patient treated by resection of the common hepatic duct with hepaticojejunostomy died of a recurrence 25 months postoperatively. Two patients underwent left hepatic lobectomy and resection of the right hepatic duct followed by hepatojejunostomy. One patient survived 25 months and died of a reccurrence, while the other patient died of abscesses of the liver ten months postoperatively.
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Surg Gynecol Obstet · May 1978
The effect of fluid infusions upon serum protein concentrations during hemorrhagic shock.
Of 24 dogs subjected to hemorrhagic shock, 12 resuscitated with intravenous infusions containing 2.5 per cent human serum albumin maintained significantly higher, p less than 0.05, serum albumin levels than did 12 others treated with Ringer's lactate solution, with or without 50 per cent dog plasma. These differences persisted for as long as six weeks after hemorrhage. ⋯ These findings corroborate the suggestion of a capillary leak of serum albumin into the interstitial space during hemorrhagic shock that persists for at least one week after hemorrhage. The administration of albumin containing solutions during the initial stages of hemorrhagic shock counteracts this albumin loss.
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Surg Gynecol Obstet · Apr 1978
Case ReportsSevere hyperchloremic acidosis complicating jejunoileal bypass.
In summary, severe hyperchloremic acidosis developed in two patients as a late complication after jejunoileal bypass for morbid obesity. This acidosis was associated with episodes of dizziness, ataxia, headache, weakness, confusion and transient loss of consciousness. ⋯ Revision of the intestinal bypass was required for correction. Special studies to rule out renal tubular acidosis were performed and definitely excluded the kidney as a source of the acidosis.
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Surg Gynecol Obstet · Nov 1977
Randomized Controlled Trial Clinical TrialPostresection stage grouping in carcinoma of the lung.
The postsurgical treatment classification and staging system for carcinoma of the lung has been evaluated in a series of 403 patients admitted to a completed prospective randomized adjuvant cancer chemotherapy trial conducted by the Veterans Administration Surgical Adjuvant Group. The proposed T, N and M classification suggested by the American Joint Committee for Cancer Staging and End Results Reporting is supported. However, the stage groupings as suggested by the Committee fails to separate adequately the various prognostic groups. ⋯ In the Joint Committee classification, these survival rates are 30.8 per cent, 25.5 per cent and 10.5 per cent, respectively. In addition, 18 patients with undifferentiated small cell carcinoma were also evaluated. The long term survival of three of sixe patients with small peripheral lesions without metastatic lymph node involvement supports the opinion that resection of these specific lesions continues to be the treatment of choice.