Surgery
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Fluoroscopy, cost, and patient transport contribute to difficulties occasionally associated with the placement of vena caval filters. Follow-up data in the literature document the use of duplex ultrasonography in visualizing the filter and determining caval patency. Filter placement at the bedside or in the vascular laboratory with duplex ultrasonography may simplify this common procedure. We have attempted to define the feasibility of this method. ⋯ Placement of vena caval filters is feasible with duplex ultrasonography. Visualization is the only limiting condition to placement and occurs rarely. Reducing the need for fluoroscopy, lowering costs, and not needing to transport the critically ill patient support the use of this system. Intravascular ultrasonography in selected patients may eliminate the need for fluoroscopic placement of vena caval filters.
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An association between smoking and impaired wound healing has been reported in retrospective studies. The smoking status of a surgical patient may be confounded by social and medical parameters. We have evaluated the effect of smoking in a test wound in volunteers, with special reference to a reliable scientific match between smokers and nonsmokers. ⋯ The synthesis of subcutaneous collagen in smokers is specifically impeded, indicating an impaired wound-healing process. Because mature collagen is the main determinator of strength of an operative wound, the results support the view that patients should be advised to stop smoking before an operation.