Journal of the American College of Surgeons
-
We have previously shown high morbidity and mortality rates in patients with acquired immunodeficiency syndrome (AIDS) who require emergency abdominal operations. In a larger series of patients, we have investigated the reasons for these findings and have hypothesized that they are primarily the result of starvation and decreased resistance to infection. ⋯ Patients who meet the criteria for the diagnosis of AIDS have increased morbidity and mortality rates after emergency abdominal operations. This, however, should not exclude these patients from operation when it is indicated because many will survive and benefit from the operative procedure. Attention to nutritional support and the early diagnosis and treatment of associated infectious complications may result in decreased morbidity and mortality rates subsequent to the emergency abdominal operations.
-
Recent studies have challenged current guidelines for prehospital fluid resuscitation. However, long-term studies evaluating the consequences of fluid restriction in uncontrolled hemorrhagic shock are lacking. This study was done to examine the long-term effects of deliberate hypotension in the treatment of uncontrolled hemorrhage. ⋯ Attempts to achieve normal MAP during uncontrolled bleeding increased blood loss, hemodilution and mortality. Hypotensive resuscitation resulted in less acidemia and improved long-term survival.
-
Scant data exists on melanoma in blacks from Africa. This study was undertaken to define factors affecting outcome of blacks from South Africa with melanoma. ⋯ The poor prognosis in black patients in South Africa is the result of delayed presentation with thick primary lesions and advanced disease. An active education program may reduce mortality by detecting the disease earlier.