摘要:

We have performed vertical staple gastroplasty, using a modification of the technique of Laws, in 100 patients. The indications for operation were strictly defined. All patients have been observed from six months to 2½ years. There were no serious hospital complications. The postoperative weight loss has been satisfactory in all patients. The overall results have been excellent in 78%, good in 11%, fair in 8%, and poor in 3%.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Cholecystectomy is the most common intraperitoneal operation done by general surgeons in this country and is generally considered safe. The incidence of cholelithiasis is doubled among cirrhotic patients, and biliary surgery in such patients carries tremendous risk, primarily due to excessive intraoperative hemorrhage. One author has reported a mortality of 83% among patients with severe cirrhosis having cholecystectomy. In this report, we review seven consecutive cirrhotic subjects having biliary surgery. There were no deaths. Blood loss roughly correlated with preoperative prothrombin times. Blood transfusions were required in five patients. Factors believed to improve operative outcome are discussed.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Patients with penetrating laryngeal trauma can present a wide spectrum of signs and symptoms. Severe trauma frequently leads to life-threatening airway compromise, whereas lesser injuries are often overlooked because of the subtlety of physical and roentgenographic findings or the severity of vascular and neurologic injuries. Increased suspicion should accompany the examination of patients who have sustained a penetrating neck injury, and such injuries demand examination by an experienced laryngoscopist. Early surgical repair is mandatory to avoid delayed complications, which can permanently impair airway, speech, and deglutition. In a series of 19 patients presented here, diagnosis was delayed in seven (37%). The most relevant factor determining return to normal voice appeared to be the presence or absence of vocal cord paralysis.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

We evaluated the indices of arterial distensibility in a group (N=40) of normotensive subjects and patients with borderline or established hypertension by measuring intra-arterial pressure, pulse wave velocity, and a mathematical modification of MOEN's formula to calculate arterial distensibility. Multiple linear regression analysis including six hemodynamic variables (systolic pressure [SP], diastolic pressure, mean arterial pressure, cardiac output, stroke volume, total peripheral resistance) and age showed that SP and age are the best predictor indices for arterial distensibility (P < .025; both inversely correlated with arterial distensibility) and for pulse wave velocity (P < .001; both positively correlated with pulse wave velocity). Patients aged 48 years and under (N=35) with no evidence of target organ damage showed significant differences in arterial distensibility (F=5.41; P < .01) among normal, borderline, and established hypertensive subjects; arterial distensibility was lower in those with borderline (P <.025) and established hypertension (P <.01) when compared with the normal group. We concluded that arterial distensibility is decreased in borderline as well as in established essential hypertension without target organ involvement and that age and systolic pressure are the best predictors of arterial distensibility.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Costs of treating 174 adult patients with acute leukemia were compiled and analyzed over the five-year period 1974 to 1979. The average overall cost per patient was $ 18,760, and increased over the period of study. Increased total hospital costs were incurred by patients who achieved a favorable response to induction chemotherapy and by those with a diagnosis of acute lymphocytic leukemia (ALL). To assess the impact of successful treatment on hospital expenditures, total months of survival were compared with total hospital costs to determine cost per month of life. Using this analysis, improved survival, favorable response to chemotherapy, and a diagnosis of ALL were associated with significant decreases in cost per month of life. The long-term survivors (alive 3≥ 2 years from diagnosis) best demonstrated this effect, with a mean hospital cost per month of survival from diagnosis of $ 563, which was significantly less than $ 6,937 for those who achieved a partial remission, $ 10,703 for those with treatment failure, and $ 8,240 for those who were untreated. These costs linked to outcome are comparable to those reported in other disorders that require prolonged and intensive hospital care. With the progressive improvement in response rate and in percentage of long-term survivors that is being observed in adults with acute leukemia, these costs should continue to decrease.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The three electrical stimulation systems available for treating nonunion of long bones are successful in approximately 85% of cases. The percutaneous direct current bone growth stimulator is partially invasive, allows patient mobility, can be used with magnetic fixation devices, and can be monitored for proper function, but it requires an operation, cannot be used where infection exists, and is subject to breakage. The implantable direct current bone growth stimulator is similar, but is totally invasive. The external pulsing electromagnetic field bone growth stimulator is noninvasive and can be used where infection exists, but it requires long, exact patient compliance and cannot be used with magnetic fixation devices or at certain sites. None of the systems can be used where synovial pseudarthrosis or a sizeable gap between bone ends exists, nor are they more effective than bone grafting. Whether their use might evoke malignant transformation or might accelerate or retard epiphyseal growth patterns is not known. Many controlled studies are needed before it is clear how commonly electrical stimulation should be used to treat bony nonunion.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The number one health problem and killer of adults in the United States is the heart attack. Since the development of cardiopulmonary resuscitation (CPR) 30 years ago, hospitals have addressed this problem by setting up coronary care units. As a result, approximately 100,000 lives are saved each year, yet an estimated 600,000 people still die each year from heart attack before they reach the hospital. To break this barrier, it is increasingly important to teach, not only CPR throughout the community, but also the early warning signs. In Maryland, a resolution by the State Board of Education and a proclamation by the Governor have jointly designated the high schools as the focal point for teaching. Patients with chest pain must be taught to enter the system early while they still have undamaged myocardium and thus a better chance to respond to modern therapy.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

An analysis of the records of 300 patients who had had 370 small-bowel radiologic examinations and a subsequent 102 patients examined by fluoroscopy and enteroclysis suggests that enteroclysis (small-bowel enema) is extremely valuable in the radiologic evaluation of small intestinal disease. Our results suggest that best results are obtained if the radiologist spends adequate time to participate in and observe the studies carefully. We believe that the fluoroscopic observation of low-density barium passing through distended small bowel gives a much clearer picture of its status than routine follow-through examinations. Disagreement exists concerning the choice of Sellink's method, using dilute barium, and Herlinger's technique, using a somewhat denser barium followed by methylcellulose. We prefer the latter. Enteroclysis probably should not be done in the presence of a high small-bowel obstruction because of the danger of reflux and aspiration. If intubation is unsuccessful, an oral study should be postponed until the effects of the topical anesthesia disappear. A controlled prospective study of the accuracy of fluoroscopic enteroclysis versus a good detailed independent follow-through examination is needed.

ISSN:0038-4348    

出版商:OVID    

年代:1984

数据来源: OVID