American journal of surgery
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Nonoperative management of blunt hepatic injury is currently a widely accepted treatment modality. Computed tomography (CT) is an important imaging study both for diagnosis and follow-up of these patients. There is, however, no reliable predictor of failure of nonoperative treatment other than the ultimate development of hemodynamic instability. Previous reports mostly were based on the data obtained from low-speed dynamic incremental scanners. The purpose of this study is to evaluate the value of a high-speed helical scanner in predicting the outcome of patients managed nonoperatively. ⋯ The presence of pooling of contrast material within the hepatic parenchyma indicates free extravasation of blood as a result of active bleeding. In patients with blunt hepatic injury, if this sign is detected, nonoperative treatment should be terminated and angiography or celiotomy undertaken promptly. With the increasing use of high-speed spiral CT scanner and improvement in scanning technique, pooling of contrast material may become a sensitive sign for active bleeding and may be used as a guide for the selection of treatment modality.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy.
Postoperative shoulder-tip pain (STP) frequently occurs following laparoscopic surgery. In an attempt to abrogate this complication we prospectively evaluated the efficacy of intraoperative irrigation of the diaphragm with bupivacaine. ⋯ Intraperitoneal irrigation with bupivacaine to both hemidiaphragms at the end of surgery significantly reduces both frequency and intensity of STP following laparoscopic procedures thus reducing patient morbidity.
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Management of the pancreatic stump after pancreaticoduodenectomy (PD) is still a matter of debate. Pancreaticojejunostomy (PJ) is used commonly but is associated with a significant incidence of pancreatic leaks. Pancreaticogastrostomy (PG) is an alternative that has been reported to be safer. ⋯ In world literature (including the current series), the leakage rate of PG is 2.5% (14 of 553) with only 2 deaths (2 of 14) due to leakage from PG. Our large experience and these data conclusively prove the safety of pancreaticogastrostomy, which should be the drainage procedure of choice for the pancreatic stump following pancreaticoduodenectomy.
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This retrospective study was undertaken to determine the mechanism by which cardiac tamponade (CT) occurs after placement of central venous catheters (CVC), and to determine if physicians are aware of this potentially lethal complication. ⋯ Cardiac tamponade from central venous catheters is preventable if the tip of the catheter is outside the cardiac silhouette on chest radiograph. Any patient with a CVC in place who develops unexplained hypotension, chest tightness, or shortness of breath should have an emergency echocardiogram to rule out cardiac tamponade.
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Morbidity is today's concern in thyroid surgery. The purpose of this paper was to quantify risk factors' contribution to morbidity rates. ⋯ High surgical volume, identifying parathyroids and RLNs, failed to reduce morbidity. Completion and total thyroidectomy with node dissection increased PH and TRLNP (not PRLNP) rates.