Annals of surgery
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This study of 73 patients with the clinical diagnosis of thromboembolism has shown that the pulse rate, respiratory rate, and arterial partial pressure of carbon dioxide have discriminatory value in identifying the group of acutely ill patients who are most likely to have pulmonary embolism. In contrast, the clinical diagnosis of deep venous thrombosis, PaO2 chest radiography and electrocardiography which are all essential to patient management have no such value. In this series, only 29% of the patients had a pulmonary arteriogram positive for thromboembolism, but the mortality rate in this group was 33%. Pulmonary perfusion scanning has been shown to be a useful and accurate screening investigation and should be routinely employed prior to pulmonary angiography if the patient is stable hemodynamically.
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The charts of 937 patients have been reviewed for survival and length of stay. Probit analysis and binary logistic regression has been performed to develop probability of dying contours incorporating age and per cent burn. It appears that improvement in survival has occurred over the last 16 years. ⋯ A significant decrease in hospitalization time has occurred in the past year with the advent of a selective wound excisional protocol, without adversely affecting survival. A burn bed requirement chart is presented which incorporates age, burn size, survival probability and predicted length of stay. The chart allows for estimation of burn bed needs for a known or predicted population of regional burn victims.
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Case Reports
Total or near total pancreatectomy and islet autotransplantation for treatment of chronic pancreatitis.
Total or near total pancreatectomy is the surest way to relieve the pain of chronic pancreatitis but is rarely applied because the metabolic consequences are so severe. For most patients drainage procedures are applicable, but pancreatectomy may be the only alternative for small duct disease or where procedures to improve duct drainage have failed. Preservation of endocrine function is a major problem in patients who require pancreatectomy. ⋯ Islet tissue preparation from a diseased pancreas is difficult. The surgeon and the patient must still be willing to accept diabetes for relief of pain when performing this operation. In some patients, however, islet autotransplantation can prevent or partially ameliorate diabetes after pancreatectomy, and preservation of endocrine function is worthwhile.
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The rationale for amputation for local tumor control of skeletal and soft tissue sarcomas was based on results obtained from surgical therapy alone. However, our previous results from a pilot trial of multimodality therapy of preoperative chemotherapy and radiation therapy followed by surgical resection indicated that limb salvage (without amputation) could be accomplished in most patients with little morbidity and low recurrence rate. This report summarizes our experience in a prospective trial from January 1972 to December 1979. ⋯ Their functional capabilities are excellent with a low complication rate. Since the advent of adriamycin and methotrexate has significantly improved the overall survival for patients with skeletal and soft tissue sarcomas, the quality of this survival has become even more important. Preoperative multimodality therapy is a major advance in this direction and since results of limb salvage procedures appear to be equal or superior to those achieved by amputation we believe these alternatives should be offered to all patients.
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A prospective study was begun in January 1975 to evaluate the effect of splenectomy on graft and patient survival in recipients of first cadaver kidney transplants. Ninety-two cases were evaluated. Splenectomy increased the survival of both grafts and recipients. ⋯ Splenectomy exerted its effect by reducing the incidence and intensity of rejection episodes. It was not clear whether the observation resulted from a direct immunosuppressive effect of splenectomy or from the increased tolerance to azathioprine observed in asplenic recipients. Finally, splenectomy negated an effect of race that had been observed earlier for survival of cadaver transplants and recipients.