RESUMEN
This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N = 59) or no peritoneal closure (N = 54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication(s), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P = .014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P = .03). The average operating time was shorter for the open group than for the closure group (P less than .005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure.
Asunto(s)
Cesárea/métodos , Peritoneo/cirugía , Complicaciones Posoperatorias , Adulto , Femenino , HumanosRESUMEN
A study of the long-term results after operation on 66 women (83 hands) with Dupuytren's disease showed that women are twice as likely as men to have a postoperative flare reaction. Why a flare reaction develops is uncertain. In this study, patients who had a carpal tunnel release at the time of operation for treatment of Dupuytren's disease or those who had an extensive fasciectomy, as opposed to removal of only the contracted tissue, were more apt to have a flare reaction. In addition, after operation, moderate or severe loss of finger flexion occurred in 35% of hands without a flare reaction and in 76% of those who had a flare reaction. This suggests that women having an operation for treatment of Dupuytren's disease are apt to have a worse result than men.
Asunto(s)
Contractura de Dupuytren/cirugía , Deformidades Adquiridas de la Mano/cirugía , Complicaciones Posoperatorias/etiología , Anciano , Fasciotomía , Femenino , Articulaciones de los Dedos/cirugía , Estudios de Seguimiento , Humanos , Articulación Metacarpofalángica/cirugía , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Forty-seven patients with unilateral hip disease had a preoperative and postoperative gait analysis of total hip arthroplasty with a follow-up period of five to ten years. The object was to correlate the levels of function with mechanical loosening. Unilateral total hip arthroplasty in uncomplicated patients restored function to 80% of normal over a two- to four-year period. Patients followed longer than five years appeared to have an accelerated decline in function unassociated with pain. No Class C patient, regardless of age or gait velocity, developed loosening or required revision of the hip prosthesis. Survivorship studies revealed an 85%-90% incidence of loosening by the seventh postoperative year in Class A patients 55 years or younger and those walking preoperatively at more than 50% of normal gait velocity. In these same two groups of patients, the probability of revision for mechanical failure by ten years is 58% for age and 66% for fast walkers. The majority of patients in this study had a technical rating not acceptable by present standards so that these results represent most likely the worst prognosis for longevity of total hip arthroplasty. In high-risk patients, protected ambulation with crutches for six months postoperation may improve their prognosis.
Asunto(s)
Articulación de la Cadera/fisiopatología , Prótesis de Cadera , Osteoartritis/cirugía , Femenino , Estudios de Seguimiento , Marcha , Prótesis de Cadera/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Cuidados Posoperatorios , Cuidados Preoperatorios , Probabilidad , Pronóstico , Factores de TiempoRESUMEN
Semen samples from 25 fertile donors and 34 infertility patients were analyzed and evaluated both fresh and frozen with the zona-free hamster egg penetration test (EPT) and the bovine cervical mucus penetration test (MPT). Cryopreserved sperm penetrated 47.2% (average) of the hamster eggs, and fresh sperm penetrated 55.9%. Frozen sperm retained 86% of the fresh EPT values (P, not significant), but only 38% of the fresh MPT values (P less than 0.001). Cryopreserved sperm yielded the same fertility classification as fresh sperm in 94% of the cases with the EPT but only 43% with the MPT. The use of cryopreserved sperm simplifies the procedure and should enable more laboratories to utilize the EPT, but the poor results with the MPT preclude utilization of cryopreserved sperm for routine fertility evaluation with the MPT.
Asunto(s)
Moco del Cuello Uterino , Fertilización , Preservación de Semen , Interacciones Espermatozoide-Óvulo , Animales , Cricetinae , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Motilidad EspermáticaRESUMEN
This study examines the craniometry of Black and White Colobus monkeys using 1072 specimens representing all the recognized subspecies (after Rahm, '70) of the genus. Seventy-six measurements were taken on each individual, and examined using canonical variates analysis and clustering by Ward's Error Sum method. The assumptions of the analytical techniques are shown to be met, and the results demonstrated to be stable. Examination of the populations for statistical difference and taxonomic distinctiveness using a multivariate extension of Mayr's Rule indicates that the taxonomy presented by Rahm ('70) is essentially correct, except that the subspecies of guereza across the northern part of Central Africa should be lumped into a single group--C. g. occidentalis--and the subspecies of montane angolan colobus in Eastern Zaire should all be lumped into C. a. ruwenzorii. The systematic patterns of the genus illustrate the whole range of the process of speciation, from barely distinct subspecies, to subspecies almost as distinct as allopatric species of the genus, and on the fully sympatric species Three major zoogeographic areas may be delineated: an East African area dominated by the effects of the Rift Valley, with a large number of subspecies isolated in forest islands; a Central African area with little subspeciation and sympatric overlap of the major species of Colobus; and a West African area with a clinal pattern of distribution of subspecies, and secondary intergradation. The arbitrary nature of Mary's Rule is also apparent. Lastly, the CVA indicated major differences across the genus to be located in the teeth and jaws, suggesting diet might be an important distinguishing feature in Colobus.