RESUMEN
Emergency surgery in 100 patients over age 70 was associated with a 31 per cent morbidity and a 20 per cent mortality, significantly greater than the 6.8 per cent morbidity and 1.9 per cent mortality following elective procedures in the same age group (P less than .0005). Sixteen per cent (100 of 613) of all geriatric patients were operated on under emergent conditions and the postoperative hospitalization was often significantly prolonged when compared with similar elective operations (P less than .05). Emergency surgery was most commonly performed on the large bowel (25%), abdominal wall (17%), stomach (17%), biliary tract (11%), and small bowel (10%). Inguinal herniorraphy was the most frequently performed elective procedure (33%), followed by colon resection (25%), and cholecystectomy (12%). Fifty-nine per cent (23 of 39) of complications associated with urgent operation and 39 per cent (16 of 41) following elective surgery involved the cardiorespiratory systems and were frequently related to underlying diseases. Of the 20 patients who died in the intensive care unit of multisystem failure, 16 had undergone emergency procedures. Elective surgery in the elderly may be performed safely; however, emergency surgery entails a high risk to the patient and a high cost in hospital resources.
Asunto(s)
Anciano , Procedimientos Quirúrgicos Operativos , Abdomen/cirugía , Anciano de 80 o más Años , Urgencias Médicas , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Riesgo , Procedimientos Quirúrgicos Operativos/mortalidadAsunto(s)
Abdomen Agudo/cirugía , Geriatría/tendencias , Abdomen Agudo/mortalidad , Factores de Edad , Anciano , Humanos , Estados UnidosAsunto(s)
Apendicitis/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Traumatismos Abdominales/cirugía , Heridas Penetrantes/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/mortalidad , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Factores de Tiempo , Heridas Penetrantes/complicaciones , Heridas Penetrantes/mortalidadRESUMEN
During the past 25 years, great progress has been made in saving patients with serious cardiac injuries. This study is based on nine consecutive cases of penetrating wounds to the heart treated successfully by surgical intervention at a community hospital with no facilities for cardiopulmonary bypass. Early surgery is advocated for patients suspected of having penetrating injury of the heart.
Asunto(s)
Lesiones Cardíacas/cirugía , Heridas Penetrantes/cirugía , Adulto , Procedimientos Quirúrgicos Cardíacos , Femenino , Hospitales Comunitarios , Humanos , Masculino , Métodos , Técnicas de Sutura , Heridas por Arma de Fuego/cirugía , Heridas Punzantes/cirugíaRESUMEN
This article reviews our experience with 403 cases of stab wounds of the abdomen, with emphasis on our policy of selective management. Forty-six percent (187) of the patients were operated on immediately because of clinical findings. Fifty-four percent (216 patients) were treated conservatively after initial evaluation, and only 4% (16 patients) required subsequent surgical intervention, with no mortalities. The overall morbidity was 9.2%, with a 1.6% mortality in the operative group. With more than 20 years of experience in the management of stab wounds, we found the selective approach to be safe and reliable.
Asunto(s)
Traumatismos Abdominales/terapia , Heridas Punzantes/terapia , Traumatismos Abdominales/mortalidad , Traumatismos Abdominales/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana EdadAsunto(s)
Traumatismos Torácicos/epidemiología , Adolescente , Adulto , Anciano , Alcoholismo/complicaciones , Niño , Femenino , Dependencia de Heroína/complicaciones , Humanos , Técnicas In Vitro , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Estudios Retrospectivos , Traumatismos Torácicos/cirugíaRESUMEN
A case of carcinosarcoma of the esophagus and a review of literature are presented. The pertinent clinical and pathological data are summarized. There have been 51 reported cases of which 31 underwent surgical resection of the lesion; there have been three five-year survivors. Although the cumulative experience with this malignancy is limited, it is apparent that the presentation and clinical course of this tumor is not substantially different from the more common squamous cell carcinoma. Therefore, the diagnostic and therapeutic management should not vary from that of any malignant esophageal lesion.
Asunto(s)
Carcinosarcoma/patología , Neoplasias Esofágicas/patología , Carcinosarcoma/cirugía , Neoplasias Esofágicas/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not entirely benign instrument. A case is desribed in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 1963 the Fogarty ballon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause. It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehensive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.