ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

An indwelling silicone rubber Dacron-cuffed catheter placed in a long subcutaneous tunnel reduces the incidence of catheter-related sepsis and facilitates dressing changes by the patient, but often necessitates tedious dissection to cannulate a satisfactory tributary of a central vein. Modification of the percutaneous technique for introducing pervenous pacing leads allows placement of central venous feeding catheters without open dissection. A Teflon sheath introducer designed to separate along its longitudinal axis is advanced into a subclavian or femoral vein over a guidewire previously inserted through a percutaneously placed needle. The “peel apart” sheath allows the insertion of the catheter and the subsequent removal of the introducer. C-arm fluoroscopy facilitates and verifies catheter placement. Experience in 31 adult and five pediatric patients has proven this technique to be simple, safe, and expedient within an average operative time of only 20 minutes (12 to 30 min). Successful insertion through the femoral vein as well as insertion under local anesthesia has been achieved without adverse effects. This technique has distinct advantages over previous techniques and lends itself well to the implantation of indwelling central venous catheters on an outpatient or treatment room basis with obviously improved cost-benefit and risk-benefit ratios.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We reviewed the cases of women admitted to LSU Medical Center in Shreveport with the diagnosis of “small bowel obstruction” from Jan 1, 1975 to June 30, 1981. Review of the charts of patients who had exploratory laparotomy for relief of the obstruction showed that 83% of them had had previous abdominal surgery. Furthermore, 67% of the patients had had an abdominal hysterectomy. In 100% of the cases of obstruction after abdominal hysterectomy, there were adhesions to the site of reperitonealization or to the anterior abdominal wall. This study shows a higher incidence of small bowel obstruction after gynecologic surgery than has been previously reported.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Considerable controversy exists regarding the optimal method of surgical relief of the pain of chronic pancreatitis. We previously made a retrospective study of 49 patients with chronic pancreatitis who were operated upon only for relief of pain. Those results indicated that patients who had an internal decompression had lower mortality, less morbidity, less postoperative pancreatic insufficiency, and better relief of pain (88% vs 76% improved). Since then, we have prospectively determined the operative treatment based upon the criteria outlined in that previous report. Seventeen patients had 19 operations (12 resections, seven internal drainage procedures). The patients' ages, duration of symptoms, and sex distribution are similar. Eighty-five percent of patients with internal decompression had good to excellent relief of pain vs 60% of patients with resection. Pancreatic insufficiency occurred in 70% of patients who had resection and in only 14% of those who had drainage. Forty percent of patients who had resection had mild to severe postoperative morbidity vs 14% of those who had drainage. There was one postoperative death in the resection group. These preliminary results indicate that internal decompression in properly selected patients can provide superior relief of pain, with lower mortality, less morbidity, and less pancreatic insufficiency.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We present six cases of pulmonary edema related to betamimetic (beta sympathomimetic amine) agents (three to ritodrine and three to terbutaline). The hemodynamic data from three patients suggest that this may be a form of noncardiogenic pulmonary edema. A seventh case, resulting in a maternal death, is included because of the association with ritodrine therapy and the instructive complications of invasive monitoring. We also propose an outline for the management of betamimetic-drug-induced pulmonary edema.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Forty-two women with primary dysmenorrhea were successfully enrolled in a double-blind, three-way crossover study in which each patient received either ibuprofen (Motrin), indomethacin (Indocin), or a placebo during each of three successive painful menstrual cycles. Thirty-one patients successfully completed the study. The results showed that ibuprofen and indomethacin were superior to the placebo in their ability to relieve pain and that patients preferred ibuprofen to indomethacin. Ibuprofen was significantly superior to the placebo regarding the number of patients who could pursue normal daily function, whereas indomethacin was not. Four patients reported side effects, all during the indomethacin cycle.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A 54-year-old woman had seizures and a focal neurologic deficit associated with hyponatremia induced by a thiazide diuretic. Prompt correction of hyponatremia by administration of hypertonic saline solution was followed by resolution of all neurologic defects. Metabolic balance studies and rechallenge with hydrochlorothiazide were undertaken to investigate the mechanism of the thiazide-induced hyponatremia. Abnormal vasopressin secretion was shown by a plasma vasopressin concentration of 0.5 μU/ml with a plasma osmolality of 268 mOsm/kg water after administration of a fluid challenge consisting of 45 ml/kg body weight. Rechallenge with chlorothiazide while on a sodium- and potassium-controlled balanced diet resulted in a decrease in serum sodium concentration (136 to 124 mEq/L) and plasma osmolality (283 to 261 mOsm/kg) within 18 hours. During this period, urine losses of monovalent cation were only 55 mEq and body weight was constant at 48.2 kg. A second challenge while the patient received all fluids and electrolytes intravenously again resulted in decreased serum sodium concentration (134 to 126 mEq/L) after urinary loss of only 69 mEq of cation. Thus this patient's hyponatremia cannot be accounted for solely by changes in external water and electrolyte balance; the rapidity with which changes were produced suggests that osmolar inactivation, probably intracellularly, may contribute to the severe hypotonicity seen in some patients.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Anticoagulant-associated adrenal hemorrhage (AAH) is an infrequent complication of therapy. It is not usually diagnosed before death, but can be successfully treated if recognized. The case presented herein and the literature reviewed emphasize the pathogenesis, clinical picture, diagnosis, and treatment. This may be the first case with histologic study after long-term survival of the initial episode.

ISSN:0038-4348    

出版商:OVID    

年代:1983

数据来源: OVID