Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Apr 1993
Ritual head computed tomography may unnecessarily delay lifesaving trauma care.
Examination of 462 consecutive patients with blunt trauma suggested reassessment of the timing of head computed tomographic (CT) scanning in the critical care of the seriously injured. Even though potential brain injury was the most common reason for admission, few (5 percent) of the patients required neurosurgical intervention. It is apparent that the more common non-neurosurgical procedures that were used to squelch hemorrhage and provide hemodynamic stability and airway control should not be delayed to obtain "routine" head CT scans.
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In the present study, generally accepted risk factors for developing a primary incisional hernia are reviewed for their influence on the development of recurrent incisional hernia. The records of 417 patients undergoing an incisional hernia repair between 1980 and 1989 at the University Hospital Rotterdam were reviewed retrospectively, and in the event no hernia recurrence was documented, patients were asked to visit the outpatient department for physical examination. Patients having a primary incisional hernia (n = 302) were selected and patient related factors of gender, age, obesity, chronic cough, prostatism, constipation, diabetes mellitus and the use of corticosteroids were analyzed. ⋯ Considering these facts, a better technique is badly needed. In large defects, the use of inlay of prosthetic material consistently has the lowest recurrence rates. The question remains whether or not prosthetic material is also needed for repair of smaller hernias.
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Surg Gynecol Obstet · Mar 1993
The impact of operative bleeding on outcome in transplantation of the liver.
Excessive operative blood transfusion has been correlated with an increased rate of infectious complications and lower survival rate after transplantation of the liver. Two hundred and five consecutive transplants of the liver, performed between January 1988 and December 1989, were studied retrospectively to determine preoperative risk factors associated with an increased operative blood loss and to evaluate the impact of operative transfusion on the outcome of transplantation. Preoperative clinical and laboratory parameters in patients who required 10 units or more of banked erythrocytes were compared with those in patients who received less than ten units of erythrocytes. ⋯ Patients who required more blood also had significantly prolonged stays in the intensive care units postoperatively (18.3 versus 6.3 days, p < 0.002) and lower graft and patient survival rates (p < 0.001 and p < 0.05, respectively). We conclude that intraoperative bleeding has remained a significant problem affecting the immediate outcome after transplantation of the liver. Preoperative parameters cannot predict operative bleeding accurately and the mainstay to prevent bleeding is a meticulous surgical technique during the hepatectomy and correction of coagulation abnormalities throughout the procedure.
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Surg Gynecol Obstet · Feb 1993
Randomized Controlled Trial Clinical TrialDiminishing blood loss during operation for burns.
The current placebo-controlled, randomized clinical trial was done to determine the effect of preoperative 1-desamino-8-D-arginine vasopressin (DDAVP) infusion on blood loss in patients undergoing burn débridement and grafting, a patient population in which extreme blood loss is a frequent occurrence. Eleven patients undergoing 22 surgical procedures completed the study protocol--mean age was 33 years (range of 12 to 70 years), mean burn size was 53 percent body surface area (BSA) (range of 17 to 92 percent) and mean area débrided and grafted was 3,935 centimeters squared (range of 848 to 8,134) or 21.1 percent (range of 4.0 to 43.5 percent) BSA. The treatment group received 0.3 microliter per kilogram DDAVP infused during 15 to 30 minutes within one hour of anesthetic induction. ⋯ No significant hemodynamic consequences or changes in routine coagulation profiles were noted in either group. No significant difference was found between the control and treatment groups in the volume of blood lost per percent BSA débrided and grafted (145.9 +/- 109.7 versus 130.2 +/- 61.7, respectively) or the volume lost per unit area débrided and grafted (0.75 +/- 0.54 versus 0.74 +/- 0.41, respectively). Based on these data, we cannot conclude that preoperative DDAVP infusion reduces blood loss in patients undergoing débridement and grafting of burn wounds.
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Surg Gynecol Obstet · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized trial of single versus multiple drains in the axilla after lymphadenectomy.
Increasing duration and amount of postoperative fluid formation after axillary lymphadenectomy delays final healing. We postulated that multiple drains (instead of a single drain) might decrease postoperative fluid accumulation by their greater proximity to points of leakage. We randomized 65 women with clinical stage I or II carcinoma of the breast to single or multiple drains. ⋯ The two arms (single versus multiple drains) were determined to be homogeneous in other variables that may affect postoperative fluid formation--age, size of the breast, weight, height, obesity, presence of previous surgical biopsy, excision of pectoralis minor muscle, excision of thoracodorsal complex, level of axillary dissection, number of lymph nodes, number and proportion of positive lymph nodes and whether or not the dominant hand was on the side operated upon. Single versus multiple drains had no clinically significant effect on the amount or duration of drainage, as an inpatient or outpatient, or total. We recommend a single drain to the axilla after lymphadenectomy.