Clayton H. Shatney

Prospective, randomized trial of the biofragmentable anastomosis ring

A randomized trial was undertaken to compare the biofragmental anastomotic ring (BAR) with conventional intraperitoneal colorectal anastomotic techniques. Patients were randomized into one of two schemes: BAR versus sutured or BAR versus stapled anastomosis. There were 782 patients entered into the study and 283 patients (36%) had a sutured anastomosis, 104 patients (13%) had a stapled anastomosis, and 395 (51%) had the BAR. Comparison of the BAR with combined suture and stapled controls revealed no significant differences in wound complication, abscess rate, bleeding, anastomotic leaks, ileus, obstruction, or deaths. There were no differences in return of bowel function, return to normal diet, or hospital stay. Intraoperative difficulties occurred in 46 BAR patients (17%), and this was significantly higher (p less than 0.001) than for sutured (3%) but not for stapled anastomoses (11%). The occurrence of these problems did not adversely effect the outcome. The data suggest that the BAR is a safe, satisfactory alternative to sutured or stapled colorectal anastomoses.

Septic sequelae after splenectomy for trauma in adults

Of 619 trauma patients who underwent splenectomy, 503 lived more than 10 days postoperatively. In this group systemic sepsis developed in 114 patients (22.7 percent). The most frequent septic focus was intraabdominal abscess (59 patients). The incidence of postoperative septic complications increased with the severity of trauma. Of the 41 patients who died after the 10th postoperative day, 36 died from sepsis. There were no septic complications or deaths in the 13 patients under age 15 years. Septic morbidity and mortality rates in splenectomized patients were significantly (p less than 0.01) greater than those in 2,368 consecutive trauma patients treated from 1978 to 1979. Long-term follow-up information was obtained in 242 patients. Follow-up encompassed 1,046 patient-years, with a mean patient follow-up interval of 4.4 years. Severe bacterial infections have occurred in six patients (2.5 percent). Thus far there have been no deaths from overwhelming sepsis. Interestingly, 11.5 percent of the patients complained of more severe viral infections after splenectomy. Our data support the concept of preserving the traumatized spleen whenever possible.

Upper-airway obstruction as a complication of oral anticoagulation therapy

We treated a patient for warfarin-induced sublingual hematoma causing upper-airway obstruction. This complication of oral anticoagulation therapy is rare; only three other cases have been reported in the English literature. All reported patients developed acute respiratory embarrassment necessitating emergency airway establishment. Sublingual hematomas usually resolve spontaneously, and surgical drainage is rarely necessary.

Diagnostic and surgical aspects of insulinoma: A review of twenty-seven cases☆☆☆

Abstract The clinical features of twenty-seven patients with insulinoma are discussed. The best diagnostic test is a seventy-two hour fast with multiple determinations of blood glucose and insulin. Preoperative arteriography and intraoperative blood glucose monitoring are recommended in all patients. In the present series there was no operative mortality, and all patients were rendered asymptomatic.

Total pancreatectomy for ductal carcinoma of the head of the pancreas: Current status

Because of dismal results after pancreaticoduodenectomy for adenocarcinoma of the head of the pancreas, a review was made of patients treated by total pancreatectomy for this condition. Although the early experience with total pancreatic resection was disappointing, the results during the past decade have been encouraging. Among the forty-two patients reported on with sufficient detail for analysis the operative mortality has been 17 per cent, and the morbidity has been 21 per cent. Sixty-five per cent of these patients (20 of 30) have survived at least one year and 53 per cent (16 of 30) have lived at least two years after surgery. The management of the diabetes and pancreatic insufficiency has not been difficult. Total pancreatectomy appears to be preferable to pancreaticoduodenectomy in the treatment of ductal carcinoma of the head of the pancreas.

Potential role of nurses in assessing house officer performance in the critical care environment

A prospective study was conducted to examine the possible contribution of acute care nurses to the evaluation of resident physicians. During a 10-month interval, 98 house officers rotating through a trauma unit were assessed by 2 staff physicians, 1 trauma/critical care fellow, and 3 registered nurses. Residents were evaluated on 33 factors related to 4 categories of activity: personal conduct, professional competence, patientoriented behavior, and interdisciplinary relations. In all 4 categories, the mean scores of the nurses were significantly (p < .05) higher than those of the staff physicians, but not significantly different from those of the trauma/critical care fellow. The mean ratings of the latter were generally between the other 2 groups of evaluators. This study revealed that nurses can participate successfully in the resident evaluation process, and that senior physicians on the acute care team are more critical of house officer performance than are nurses or fellows on the team.

Prolongation of pancreatic allograft survival by 5-fluorouracil

Recipient survival in canine pancreatic allotransplantation was significantly prolonged when animals were treated with 5-fluorouracil in combination with low-dose azathioprine. Untreated dogs and those receiving only azathioprine survived for only short periods of time, and pancreatitis was frequently encountered. In contrast, animals treated with 5-fluorouracil were protected from pancreatitis and survived an average of almost three weeks.