Surgery
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An approach to the repair of injuries of the bifurcation of the inferior vena cava and aorta is presented. This method involves division of the right common iliac artery with mobilization of the aorta for exposure of wounds to the confluence of the common iliac arteries as well as of the posterior wall of the distal aorta. Wide exposure of this area allows for more rapid control of bleeding vessels in addition to more precise vascular repair.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized, prospective trial of cimetidine and ranitidine for control of intragastric pH in the critically ill.
Forty-eight critically ill patients in an intensive care unit were enrolled in a prospective study of stress ulcer prophylaxis. The H2-receptor antagonists cimetidine and ranitidine were used, patients being randomized on hospital number. Response was assessed by measuring gastric pH every 2 hours. ⋯ However, even with much lower plasma concentrations of ranitidine, similar amounts of both drugs were present in the gastric juice, suggesting a possible explanation for the greater efficacy of ranitidine. We conclude that, although ranitidine is more effective than cimetidine, neither of these drugs is adequate for stress ulcer prophylaxis. If they ae used for this purpose in the critically ill patient, regular monitoring of gastric pH is essential to allow detection of therapeutic failures.
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The hypothesis is presented that paraplegia after coarctation of the aorta is principally due to hypotension of sufficient severity and duration. In a group of 103 patients who underwent surgery during a 10-year period, the distal aortic pressure was maintained above 60 mm Hg while the aorta was cross-clamped or the period of cross-clamping was limited to less than 20 minutes. No neurologic problems occurred. ⋯ In five of six patients with large thoracicoabdominal aneurysms in whom sensory potentials were absent for longer than 30 minutes, paraplegia resulted. Use of somatosensory potentials provides a significant method for evaluating methods to protect from paraplegia. This method should be far more productive than are simple clinical experiences because the fortunate rare occurrence of paraplegia, one in 200, greatly limits available data.
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A 21-year-old man presented with fever and septicemia resistant to antibiotic therapy. An unusual post-coarctation mycotic aortic aneurysm that had eroded into the left main stem bronchus was identified and replaced with a Dacron graft. A critical factor in achieving the satisfactory result was preparation of the femoral vessels for autotransfusion and possible cardiopulmonary bypass.