Annales chirurgiae et gynaecologiae
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The metabolic response to major thermal injury is characterized by gross hypermetabolism with increased basal metabolic rate, increased oxygen consumption, negative nitrogen balance and weight loss. Failure to provide burn patients with sufficient exogenous caloric and nitrogen intake results in catabolic sequelae; impaired wound healing, severe disturbances in regulation of cardiovascular, pulmonary and hepatorenal functions, as well as decreased resistance to infections leading to overt septic episodes. Vigorous nutritional therapy is therefore essential for the survival and optimal care of burn victims. In addition to enteral nutrition -- either by the oral route or with the help of tube feeding, parenteral nutrition is usually required to satisfy the extremely increased energy and protein requirements of the severely burned patient.
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This study presents a series of 38 patients in whom total hip replacement was performed by using a hypotensive anaesthetic technique with moderate haemodilution. 17 patients operated on during normotension without haemodilution served as controls. Halothane, d-tubocurarine and pentolinium tartrate were the agents used. During the operation circulation was monitored carefully. ⋯ No complications attributable to the hypotensive technique occurred. The results suggest that the hypotensive anaesthetic technique with haemodilution reduces the need for blood transfusion in major surgery. However, only patients in good cardiovascular status are suitable for this technique, and careful monitoring of the circulation is mandatory during the anaesthesia.
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Comparative Study
Segmental epidural analgesia and postpartum sequelae.
The incidence of the postpartum sequelae of headache, backache, pain in the legs and difficulties in micturiton, was studied in 219 normal vaginal deliveries. 135 of the parturients received continuous segmental epidural analgesia at the level of Th 10--12 for pain relief during the first stage of labour. The remaining 84 parturients served as controls. The results showed that segmental epidural analgesia did not increase the occurrence of postpartum sequelae either in primiparous or in multiparous parturients.
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Forty-five patients with multiple injuries treated at an intensive care unit were studied prospectively. The patients were divided into two groups: the severely injured (no mortality) and critically injured (56% mortality). Treatment was started within two hours from the accident in all cases. ⋯ The factor V and fibrinogen levels were initially lowered. Low platelet values at 2-4 days, prolonged thrombin and r-times, secondary decrease of fibrinogen FV, FVIII, and low Thrombotest values suggested disseminated intravascular coagulation associated with complications, such as fat embolism and "shock lung" syndromes. General bleeding tendency with high mortality was observed in 16% of the patients.
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Comparative Study Clinical Trial Controlled Clinical Trial
Comparison of muscle relaxants in clinical use.
A prospective clinical comparison of d-tubocurarine, alcuronium, gallamine and pancuronium was performed in 400 surgical patients. Various parameters usually followed during clinical anaesthesia were recorded from the beginning of, to the recovery from anaesthesia. Endotracheal intubation was performed with or without suxamethonium. ⋯ Pancuronium and alcuronium caused least changes in the cardiovascular parameters. Erythematous skin reactions were seen mostly after the use of d-tubocurarine and suxamethonium. This could depend on histamine liberating potency of these muscle relaxants.