Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Mar 1992
Randomized Controlled Trial Clinical TrialTolerance to enteral tube feeding diets in hypoalbuminemic critically ill, geriatric patients.
Tolerance of elemental (for example, Peptamen [PEP]) or free amino acid (for example, Vivonex TEN [VIV]) tube feeding diets is controversial, especially in the critically ill patient who is hypoalbuminemic. A prospective, randomized trial was conducted to compare differences between feeding PEP (n = 8) or VIV (n = 8) in critically ill, elderly (average age of 66 years) patients. Diets were administered through nasogastric or postpyloric feeding tubes. ⋯ Serum albumin concentrations upon initiation of the diets were 2.3 grams per deciliter in both groups. We conclude that tolerance to the two diets were similar because it was possible to feed enterally either PEP or VIV in critically ill, hypoalbuminemic patients (serum albumin concentrations of less than 2.5 grams per deciliter) successfully, irrespective of diet. Although there were more stools in the VIV group, this did not reduce compliance with the goals.
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Surg Gynecol Obstet · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialA randomized comparison of patient-controlled versus standard analgesic requirements in patients undergoing cholecystectomy.
In the current study, 55 patients undergoing elective cholecystectomy were randomly allocated to receive postoperative analgesia (morphine sulfate) administered through either patient-controlled intravenous (PCA) or standard intramuscular (IM) routes. There were no significant differences in length of hospitalization or required dose of morphine sulfate. Patients randomized to PCA reported significantly improved subjective relief from pain and a smaller percentage of time in pain during each of the first two postoperative days. ⋯ Theoretically, PCA regimens can deliver narcotic analgesia at a higher and more varied rate (with fewer side effects) compared with standard IM narcotic delivery, which is more limited by considerations of clinical doses. In PCA dosing, patients should experience less time in pain and sedation. The results of the current study support this premise.
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Surg Gynecol Obstet · Mar 1992
Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy.
Forty-six patients initially treated for carcinoma of the breast by tumor excision and radiation therapy who had local and regional recurrence with no evidence of distant disease and who underwent salvage mastectomy at Memorial Sloan-Kettering Cancer Center between 1970 and 1990 were reviewed retrospectively. These patients represent a recent series of patients treated with breast-conserving surgery, radiation therapy and subsequent salvage mastectomy with a median follow-up period of five years (range of one to 20 years). The mean age at initial diagnosis was 52 years (range of 31 to 75 years). ⋯ The median time to relapse was 97 months (+/- eight months) and the median survival time was 103 months (+/- seven months). The local recurrence rate after salvage mastectomy was 15 per cent. These data suggest that salvage mastectomy provides local control of recurrent carcinoma of the breast and relapse-free survival time may be improved by postsalvage systemic therapy.
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Surg Gynecol Obstet · Mar 1992
Recognition, resuscitation and management of patients with penetrating cardiac injuries.
To identify evolving strategies for resuscitation and definitive management of penetrating cardiac injuries, a retrospective review of 23 such trauma victims who presented with at least one sign of life was performed. Twenty-two of 23 patients survived. ⋯ No statistically important differences could be identified, suggesting that appearance at presentation does not predict severity of injury and that aggressive resuscitation and early specific diagnosis, therefore, are important to high survival rates. Rapid volume infusion and prompt drug assisted endotracheal intubation expedited the resuscitation of unstable patients and avoided the need for thoracotomy in the emergency department in 13 of 15 instances.