Nonoperative management of blunt splenic trauma: a multicenter experience.

The experience of six referral trauma centers with 832 blunt splenic injuries was reviewed to determine the indications, methods, and outcome of nonoperative management. During this 5-year period, 112 splenic injuries were intentionally managed by observation. There were 40 (36%) patients less than 16 years old and 72 adults.

Intrauterine insemination of cryopreserved donor semen.

The use of cryopreserved specimens is becoming the standard of care for donor insemination. Commercial specimens often have low numbers of actively motile sperm. Intrauterine insemination may be of value in the wives of men with oligoasthenospermia.

Tenosynovial lipochondromatosis of the flexor hallucis, common toe flexor, and posterior tibial tendons.

Presented is a case report of a girl with a lipomatous lesion of the medial ankle with chondromatous transformation of the sheath of the common and great tow flexor tendons. The lesion was completely excised. Histologic examination confirmed the diagnosis of tenosynovial lipochondromatosis of the involved tendons.

Intraoperative rapid autologous blood transfusion.

Intraoperative rapid autologous blood transfusion is a resource that is available in many operating suites but is currently underused in gynecologic surgery. A case is presented in which an intraoperative autotransfusion of 1560 ml of free intraperitoneal blood was performed to aid in resuscitation of a 31-year-old woman with a ruptured tubal pregnancy.

Delayed primary closure after sternal wound infection.

Infected median sternotomy is a major complication of cardiac operations. Over a 30-month period, 25 sternal wound infections were treated at a single institution. Twenty-four (2.

A laparoscopic approach can be applied to most cases of ectopic pregnancy.

Recent studies have demonstrated lower cost and morbidity associated with laparoscopic treatment of ectopic pregnancy. However, the applicability of these techniques to unselected cases of ectopic pregnancy has not yet been proved. To test the efficiency of the laparoscopic approach, an attempt was made to apply these techniques to all patients who presented with ectopic pregnancy at a medical center during a 6-month period and who met the entry criteria of hemodynamic stability; location other than abdominal with fetus, interstitial, or cervical; and visibility of the mesosalpinx.

Severe hepatic trauma: a multi-center experience with 1,335 liver injuries.

The experience of six regional trauma centers with severe hepatic trauma was reviewed to identify trends in management, mortality, and postoperative complications. During the 5-year period ending June 1987, 210 complex liver injuries were identified at laparotomy. There were 92 Class III, 59 Class IV, and 59 Class V injuries.

Temporary blindness associated with traumatic asphyxia.

Traumatic asphyxia is an uncommon syndrome of craniocervical cyanosis, facial petechiae, and subconjunctival hemorrhages following severe crush injury to the thorax. Ocular manifestations of the syndrome have rarely been reported. A 42-year-old male sustained temporary blindness in association with traumatic asphyxia.

Does adjuvant radiotherapy have a role in the postmastectomy management of patients with operable breast cancer--revisited.

About 2 decades ago, "routine" adjunctive postmastectomy radiotherapy, especially for axillary node-positive patients, was the norm and uncriticized standard against which adequate treatment was measured in most centers. With the advent of cyclic, aggressive, multi-agent chemotherapy and anti-hormones used as adjuvants, especially within the last decade, there has been tremendous reduction in patients referred to the radiation oncologist for consideration of adjunctive postmastectomy radiotherapy. This presentation will attempt to define a role for radiotherapy in at least selected subsets of patients who undergo modified radical mastectomy, based upon published series in the literature.

Wound complications after infrainguinal bypass. Classification, predisposing factors, and management.

We studied 135 patients during a three-year period to determine the incidence and treatment of wound complications after infrainguinal bypass. The site of distal anastomosis was the popliteal artery in 113 patients, tibial artery in 20 patients, and sequential bypass in two patients. Autogenous vein was used for 79 grafts (59%), polytetrafluoroethylene for 53 grafts (39%), and a composite for three grafts (2%).

Surgical treatment of renal cell carcinoma involving the inferior vena cava.

Renal cell carcinoma extends into the inferior vena cava in 5% of patients undergoing exploratory surgery for this malignancy. If the tumor is left unresected, death within 1 year is certain. In addition, caval occlusion may result in massive lower extremity edema, ascites, hepatic failure, and pulmonary embolus.