Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Jun 1977
Comparative StudyRelative hemodynamic effectiveness of whole blood and plasma expanders in burned patients.
In a series of nine fatally burned patients, hemodynamic and oxygen transport measurements were made before, during and after 56 administrations of 500 milliliters of whole blood or colloids and 1,000 milliliters of crystalloids. To enhance comparability, 38 of these studies were conducted at intervals on the same patient, the patient serving as his own control. ⋯ Adequate nutrition is also needed for the increased metabolic needs of the burned patient. Without supplemental nutrition, high grade plasma proteins and tissue proteins may be expended as energy substrates; the lowering of plasma proteins tends to redistribute water from the plasma to the interstitial phase, which increases further the peripheral edema.
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Although the diabetic patient is at high risk for transplantation and the progression of cardiovascular disease continues, results of our experience indicate that kidney transplantation can be performed with only slightly less favorable results than in the nondiabetic patients. We have found that the survival rate achieved by diabetics who receive a kidney graft is superior to that achieved by diabetic patients who receive dialysis. We also believe that some of the secondary complications of diabetes, which are aggravated by uremia, will be improved and that successful vocational rehabilitation is possible in the majority of diabetic patients.
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Surg Gynecol Obstet · May 1977
Delayed hypersensitivity reactions in patients with carcinoma of the colon and rectum.
Two hundred and thirty-seven patients with carcinoma of the colon and 16 patients with benign lesions of the colon and rectum underwent skin tests with 2-4, dinitrochlorobenzene and a battery of intradermal antigens. The incidence of 2-4, dinitrochlorobenzene reactors decreased with the increasing stage of the disease. Seventy-six per cent of the patients with Dukes' A cancer were 2-4, dinitrochlorobenzene positive compared with 56 per cent of those with Dukes' B cancer and 61 per cent of those with Dukes' C lesions. ⋯ A similar relationship was observed in a group of patients with advanced or recurrent disease who were observed for nine months in which 58 per cent of the patients in the 2-4, dinitrochlorobenzene negative group were dead of disease compared with 40 per cent of those in the 2-4, dinitrochlorobenzene positive group. Skin testing with 2-4, dinitrochlorobenzene and selected intradermal antigens adds prognostic information to that predicted from the clinicopathologic stage of the disease in instances of carcinoma of the colon and rectum. In general, patients with reactive skin tests have more favorable recurrence and survival rates with each stage of the disease.
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Diagnostic barium enema is not a substitution for well executed physical examination, and its use should be reserved only for obscure situations. An abnormal roentgenogram provides valuable information, since the fear of missing acute appendicitis in these children is minimized. When normal, this diagnostic test may bring to early operation those with minimal symptoms or unusual presentations, thus avoiding the possibility of prolonged observation and perforation. ⋯ The use of diagnostic barium enema in the past three and a half years significantly improved our diagnostic capabilities in children with abdominal pain. There was a corresponding reduction in the number of normal appendixes removed. The efficancy and, above all, the safety of this procedure make it a valuable diagnostic aid in the care of children.
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Surg Gynecol Obstet · Jan 1977
The surgical management of diverticular disease of the colon complicated by perforation.
Thirty instances of perforating diverticulitis seen at the University of Alabama Hospital were retrospectively reviewed. The correct diagnosis was assumed prior to operation in only 12. A palpable mass located in the lower part of the abdomen was found in 15 patients. ⋯ Seven patients, five with symptoms highly suggestive of a diverticular disease of the colon, were operated upon for suspected gynecologic problems. It appears that the patients in this group could have been treated more appropriately if the diagnosis of a perforating diverticulitis had been considered preoperatively. It is important to determine whether or not the perforation is pericolic, intramesenteric or free, with spreading peritonitis, since the advocated treatment is different for each type of perforation observed.