Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Feb 1991
Comparative StudyCorrelation of APACHE II score, drainage technique and outcome in postoperative intra-abdominal abscess.
The APACHE II Score was used to stratify retrospectively severity of illness in 91 patients postoperatively undergoing drainage of intra-abdominal abscesses. The method of initial abscess drainage (percutaneous or operative) was selected by the attending physician. The two groups of patients, those whose initial drainage was performed percutaneously versus operatively were similar with respect to age, sex, abscess location and, most importantly, severity of illness as assessed by the APACHE II score calculated on the day of their abscess drainage. ⋯ While chi-square analysis demonstrated independence between outcome and drainage technique, outcome was dependent upon severity of illness (p less than 0.0005). Paradoxically, despite the attractiveness of a percutaneous technique for abscess drainage in the most ill patients, in this series, a better, although not statistically improved, chance for survival was noted with surgical treatment. We recommend that an objective severity scoring system be used whenever assessing results of treatment of intraabdominal infection and that surgical treatment not be avoided because the patient is considered to be too ill.
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Surg Gynecol Obstet · Feb 1991
Simple technique for long term central venous access in the patient with thrombocytopenic carcinoma.
A technique for the insertion of a central venous access device in the patient with thrombocytopenia is described. Using the Seldinger technique, a wire is placed into the internal jugular vein. A catheter tunneled from the anterior part of the chest is inserted through a peel-away sheath into the central venous system. The incision is then closed.
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Victims of penetrating trauma often arrive at a trauma center within minutes of sustaining their injury but nevertheless are in a state of deep circulatory shock. Such patients require extensive resuscitative efforts; in particular, some benefit from rapid, massive normothermic fluid resuscitation. During an initial one year period, 153 of 730 patients required immediate operation and, of these, 33 required rapid infusion defined as greater than 5 liters per hour during the first hour. ⋯ There was a statistically significant improvement in clinical flow rates, decrement in resuscitation times and unexpected survival. In particular, the latter group (nine survivors) included four who were clinically dead in the field or on arrival at the trauma center, or both. Rapid infusion of normothermic fluids may be of benefit not only in penetrating trauma but also more generally in the management of massive hemorrhage.
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Surg Gynecol Obstet · Oct 1990
Comparative StudyImmediate preoperative phlebotomy with autologous blood donation for aortic replacement.
The preferential use of autologous blood provided by phlebotomy can reduce the need for homologous blood transfusion in patients undergoing extensive elective operations. This blood is usually provided either by intraoperative isovolemic hemodilution or phlebotomy one to two weeks preoperatively. To minimize the intraoperative time delay or preoperative period between phlebotomy and operation required in these patients, we performed preoperative isovolemic hemodilution in 69 patients one to two days prior to elective aortic replacement for infrarenal aneurysmal disease. ⋯ Surgical treatment of large aortic aneurysms is frequently performed on an urgent basis; thus, provision of autologous blood for this operation in a short period of time may be beneficial. Isovolemic hemodilution performed during the immediate preoperative period can reduce homologous blood requirements and be safely performed without adverse effects on mortality, morbidity and myocardial performance. Exclusion aneurysmorrhaphy may further reduce dependence on homologous blood.
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Surg Gynecol Obstet · Sep 1990
Tourniquet technique for reduced blood loss and wound assessment during excisions of burn wounds of the extremity.
Our surgical technique incorporates the advantages of previous techniques with some additional advantages described herein. We have found it a safe and effective method to reduce intraoperative bleeding, allow for intraoperative inspection of excised wounds and prevent the need for massive transfusions during excisions of burn wounds of the extremity.