Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Jul 1992
A study of cholelithiasis during pregnancy and its relationship with age, parity, menarche, breast-feeding, dysmenorrhea, oral contraception and a maternal history of cholelithiasis.
We prospectively studied 512 consecutive women attending the antenatal clinic of the Rotunda Hospital of Dublin, Ireland, to assess the prevalence of gallstones among them and to describe the characteristics of those women found to be gallstone-positive (group 1), compared with the negative-control population (group 2). Real-time ultrasound scanning of the pelvic area was extended to the upper part of the abdomen. Cholelithiasis was detected in 23 patients. ⋯ Also, early pregnancies, age at menarche and oral contraception did not have any significant difference between the two groups. However, we recorded a significantly higher prevalence of cholelithiasis in older women and in patients with dysmenorrhea. A positive trend was found in patients who had a history of previous breast-feeding and in women with a positive maternal history of symptomatic gallstones.
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Surg Gynecol Obstet · Jun 1992
Factors influencing urinary tract retention after elective open cholecystectomy.
We studied a retrospective cohort of 360 consecutive patients who had undergone elective cholecystectomy using general endotracheal anesthesia to determine risk factors associated with postoperative retention of the urinary tract. Male gender, increased age, a longer operating time and higher total doses of analgesic agents given postoperatively were each significantly associated with an increase in urinary tract retention. The use of postoperative intravenous patient controlled analgesia was associated with increased retention after controlling for other risk factors. Physicians should consider inserting a Foley catheter preoperatively in patients undergoing a cholecystectomy who are scheduled to receive postoperative patient controlled analgesia.
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Surg Gynecol Obstet · Jun 1992
Biography Historical ArticleThe life and contributions of Doctor George Nicholas Papanicolaou.
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There has been an increasing need for safe and efficient means of establishing vascular access in the patient with cancer. Recently, the use of percutaneous cannulation of the central veins, using guidewires, venous dilators and tearaway introducer sheaths, has become a popular method of establishing such access. The greatest concerns with the use of such catheters include sepsis, thrombus formation within the vein and catheter malfunction. ⋯ Although there was no significant difference in septic complications and thrombus formation between the two groups, there was a significant (p less than 0.05) difference in catheter malfunction. Patients with Hickman catheters experienced significantly less problems with one way intermittent and one way catheters than did patients with Groshong catheters. We conclude that, based on catheter function, the Hickman catheter appears to be a more favorable alternative when compared with the Groshong catheter in the patient with cancer.
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We reviewed retrospectively 233 consecutive patients with retroperitoneal hematoma (RPH) resulting from blunt trauma. This study group represented 2.9 per cent of all admissions for blunt trauma and 13 per cent of all admissions for blunt abdominal trauma. Motor vehicle accidents predominated as the cause of injury. ⋯ Patients with zone III RPH associated with fractures of the pelvis should be explored only rarely--when main iliac vascular injury is suspected (4.6 per cent in this series). Otherwise, a systematic approach using external fixator devices and angiographic embolization should be used. The over-all morbidity and mortality rates of 59 and 39 per cent, respectively, emphasize the need for aggressive resuscitation, rapid control of hemorrhage and a multidisciplinary approach to the management of these patients.