Surgery
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We compared the response of the pulmonary microcirculation to fluid overload before and 24 hours after hemorrhagic shock, resuscitated with either blood or crystalloid, to determine whether vascular permeability was altered, making the lung more susceptable to fluid overload after shock and whether this response differed depending on the type of resuscitation fluid. Fourteen unanesthetized sheep with chronic lung lymph fistula were given a fluid challenge (one half of blood volume) before and 24 hours after hemorrhagic shock. Seven sheep were resuscitated after whock with shed blood and seven sheep were resuscitated with Ringer's lactate alone equal to 2.5 times the amount of shed blood. ⋯ In the crystalloid group, fluid loading after shock produced an increase in pulmonary vascular pressures resulting in a significant increase in QL over the preshock fluid response with the mean time for QL to return to baseline being 10.1 hours. However, changes in the value of (pi p-pi i) were identical to those seen before shock. Therefore we noted that 24 hours after shock, lung permeability was not significantly altered but crystalloid resuscitation did make the lung more susceptible to volume overload.
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Transcutaneous electrical nerve stimulation (TENS) was evaluated as a postoperative analgesic. Patients undergoing lumbar spine operations, hip surgery, and gynecological laparotomies were studied. ⋯ Results from 46 experimental patients demonstrated that TENS could reduce the demand for postoperative narcotics in a group of patients who had not used narcotic analgesics before operation. No significant benefit was observed for patients who had used narcotics prior to operation.
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The effect of thrombocytopenia on the pulmonary and systemic hemodynamics of canine endotoxin shock.
Dogs were made thrombocytopenic (platelet count less than 12,000) with serial intramuscular injections of goat antiplatelet serum (APS), and the hemodynamic response to 1 mg/kg of E. coli endotoxin administered intravenously was studied. Intramuscularly administered APS rendered dogs thrombocytopenic without major alteration in other blood elements or coagulation parameters. The response of normal dogs to endotoxin was a fall in systemic blood pressure and cardiac output (CO) with an increase in pulmonary artery (PA) pressure and an increase in pulmonary vascular resistance (PVR) to 600% of control with a minimal fall in mean left atrial (LA) pressure and pulmonary artery wedge (PAW) pressure. ⋯ Cinemicroscopic studies of the lung in vivo showed marked and prolonged slowing of the microcirculation following endotoxin administration in normal dogs. In thrombocytopenic animals slowing of the pulmonary microcirculation was brief and mild. We conclude that platelets are an essential component for the initial pulmonary hypertensive response to infusion of E. coli endotoxin in dogs.
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Although the occurrence of an arterial embolus is usually a cataclysmic event prompting emergency presentationand early diagnosis, we have managed 22 patients who presented more than 48 hours after the onset of symptoms. The diagnosis was apparent in only six patients. The remainder had subacute limb ischemia, and arteriography was used to help delineate the diagnosis in 14 of these patients. ⋯ Two patients died (mortality rate of 9%), and the limb salvage rate for the 25 limbs explored was 88%. Among 22 lower extremity embolectomies, foot pulses were restored in 13 patients (59%), and four patients (18%) had viable extremities without pulses. Adjunctive arterial reconstruction was required in three patients.