Canadian journal of surgery. Journal canadien de chirurgie
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Charts of all patients who underwent splenectomy between 1965 and 1981 at the Orillia Soldiers' Memorial Hospital were reviewed. At the end of 1983, the patient, relatives or family physician were contacted for follow-up. Eighty spleens were removed, 36 for medical reasons, 30 for trauma and 14 because of iatrogenic injury. ⋯ Three died in the postoperative period and seven died of unrelated causes. Three patients died of overwhelming sepsis, 1, 3 and 7 years after splenectomy. If the three postoperative deaths are excluded and it is assumed none of the 16 untraced patients died of overwhelming sepsis, the incidence of death from this cause was 3.9%.
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A 67-year-old man with upper esophageal dysphagia thought to be caused by a large Zenker's diverticulum was found to have esophageal web at the time of diverticulectomy and cricopharyngeal myotomy. The web was divided by sharp dissection. Untreated, this thin web would almost certainly have resulted in dysphagia postoperatively. The authors therefore recommend routine open diverticulectomy for the management of Zenker's diverticulum, to allow inspection of the esophageal lumen for concomitant disease and palpation of the cricopharyngeal muscle at the time of myotomy.
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Surgical teachers are interested in being evaluated. In a survey of 89 such teachers at the University of Manitoba, most (79%) preferred having their undergraduate teaching evaluated by their students to other methods of evaluation. ⋯ In order for the evaluation to be effective in improving undergraduate teaching, there must be serious faculty commitment, the teachers must know the criteria for evaluation, and feedback to the teachers should be early and preferably coupled with teacher self-assessment. This paper lists criteria for the evaluation of surgical undergraduate teachers and outlines the evaluation instrument currently used in the Department of Surgery at the University of Manitoba.
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In 16 anesthetized dogs, low-pressure pulmonary edema was induced by the intravenous infusion of oleic acid (0.02 mL/kg). One group of four animals served as controls. In the remaining 12 animals, the pulmonary capillary wedge pressure (Pcwp) was lowered in an effort to decrease the accumulation of extravascular lung water (EVLW). ⋯ In four dogs, reduction of the Pcwp did not decrease the accumulation of EVLW but did reduce the rate of accumulation. In animals in which the EVLW reached a minimum, restoration of Pcwp to baseline values did not increase edema, while the control animals continued to deteriorate. Presumably, changes in tissue and lymphatic dynamics compensated for the increased capillary permeability.
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Abscess of the spleen is a rare entity. It may develop after generalized infection, hematologic disorders and trauma. The authors report the case of a 7-year-old boy who presented with a 2-month history of spiking fever, anorexia, fatigue and weight loss. ⋯ Although splenectomy has been advocated as the treatment of choice for splenic abscess, this patient was treated successfully with appropriate antibiotics and simple drainage, preserving the spleen. Cultures grew Staphylococcus aureus. Of all the diagnostic methods available, ultrasonography is the least invasive study that will make the diagnosis and is less expensive than some methods.