摘要:

Since the introduction of cardiopulmonary resuscitation (CPR) 25 years ago, there have been many advances in cardiopulmonary technology and in our understanding of the factors leading to a successful outcome. Despite these advances, our study of outcomes in 88 patients having CPR at Johns Hopkins Hospital in 1981 revealed a 14% survival rate to discharge compared with 24% from the same hospital from 1959 to 1961. We found that 74% of the 46 patients who initially survived CPR died before discharge. In addition, two of 12 survivors at discharge were dead one week later and one was in a persistent vegetative state three years after CPR. Our findings suggest that this technology, once meant to be applied when cardiac arrest was sudden and unexpected, is now being applied to patients regardless of underlying condition or prognosis. A follow-up survey of 63 Maryland hospitals revealed that many lacked formal plans for CPR management or education. We recommend that a comprehensive approach to CPR be adopted by all hospitals, involving (1) education regarding appropriate patient selection, (2) assurance of skilled application and backup care for survivors, and (3) a mechanism for routinely monitoring outcome.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We have used the island gluteus maximus musculocutaneous flap to cover sacral pressure sores. In this report, we describe the surgical anatomy, cadaveric dissections (n = 25), and postoperative follow-up (one to 40 months) in 13 clinical cases. Our results compare favorably with those of other previously reported series. Postoperative complications are few (n = 2) and late recurrence is acceptable (n = 1). Since the surgical anatomy is consistent and the operative technique simple, this procedure may be the treatment of choice for sacral pressure sores.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Treatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients were in shock. Injured most frequently were the iliac vessels (36%) and the inferior vena cava (20%). Suture repair with preservation of function was possible in 61%; ligation of the damaged vessel was necessary in 24 cases (26%). Overall mortality was 29%. Military anti-shock (MAS) trousers were used in the management of ten patients who had an average admission systolic blood pressure of 52 mm Hg; 50% survived. In six cases of refractory hypotension or cardiac arrest, thoracotomy was done in the emergency room; mortality in this group was 100%. For some abdominal vascular injuries, ER thoracotomy has a very limited application. The key factors for increasing the survival rate in patients with major abdominal vascular injuries include rapid stabilization, reversal of hypotension (especially by the use of MAS trousers), and prevention of coagulopathy, combined with prompt surgical exploration and thoracotomy when indicated.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We tested 18 surgical patients before and after operation in an effort to determine whether or not laboratory tests could be used as predictors of deep venous thrombosis. During the period of study, none of the patients tested had deep venous thrombosis. Coagulation tests showed no significant changes, but all tests used to measure platelet numbers and functions yielded different preoperative and postoperative values. Testing of spontaneous platelet aggregation and platelet aggregate ratios suggested that some patients had hyperactive platelets preoperatively. Some postoperative changes suggested selective use of hyperactive platelets, but we could not determine the usefulness of such tests as predictors of thrombosis.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Current anticoagulation practices of physicians in an academic medical center were examined by retrospective review of records of 26 patients admitted for uncomplicated deep venous thrombosis (DVT) between 1978 and 1982. Patients received intravenous heparin for an average of 11.5 ± 2.8 days. Warfarin therapy was started on day 8.3 ± 3.1 and therapeutic oral anticoagulation was achieved by day 14.5 ± 4.5. Total hospital stay averaged 16.8 ± 5.1 days. No patient received concurrent initiation of heparin and warfarin therapy and only two patients received warfarin before day 5. These findings are in contrast to anticoagulation practices in Great Britain and Scandinavia where concurrent initiation of heparin and warfarin has been common practice for many years. Such a regimen is safe and usually requires fewer days of hospitalization for DVT. We conclude that failure to start warfarin therapy on the first hospital day resulted in a costly and unnecessarily prolonged hospital stay.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Continuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 121/2 -year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating conditions. Careful patient selection and preparation, expertise in administering continuous epidural anesthesia, and understanding of the demands of the operative procedure are essential when planning epidural anesthesia for cesarean hysterectomy.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Using data from a sample of more than 2,000 women with breast cancer, we examined relationships between 11 variables. In Oklahoma, breast self-examination (BSE) seems to be practiced more among younger, white, metropolitan women, indicating that educational efforts should be directed toward other groups. Tumors found by BSE were found at a significantly earlier stage than tumors that patients casually discovered. There was no significant difference in the stage of tumors found by BSE, routine physical examination, or screening, but the median size of tumors found by BSE was smaller than that for tumors detected by any other method except screening. Since BSE is the least costly examination, we believe educational efforts designed to increase the use of BSE would be worthwhile. Marital status, family history of cancer, and history of benign breast disease did not appear to be related to either method of detection or stage.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We studied the presentation and results of medical therapy in 25 children with sex-linked dominant hypophosphatemic rickets. The average age at diagnosis was 3.8 years. Reasons for the delay included misdiagnosis and failure to recognize the normal range of serum phosphorus levels in children. Early diagnosis and treatment (before age 1) was associated with normal alignment of the lower limbs. Combination therapy with phosphate and vitamin D2 improved growth and bone mineralization, but did not change the height percentile or limb alignment. Limited use of calcitriol (1,25-dihydroxyvitamin D3) was not helpful in the adolescent but was associated with limited height increase in two younger children. Early diagnosis and medical therapy should prevent bowing of the legs.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Our assessment of the surgical correction of bowleg deformity in eight patients with sex-linked dominant hypophosphatemic rickets showed the best results in patients having staged, proximal tibial osteotomies at completion of growth. Lack of medical therapy was associated with recurrent genu varum or markedly delayed union. Undercorrection may be prevented by using the hip-knee-ankle axis to plan the realignment procedure.

ISSN:0038-4348    

出版商:OVID    

年代:1985

数据来源: OVID