[Splenectomy for injury: residual splenic parenchyma and incidence of infection in the follow-up of 25 patients].
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Biomedical subjects
Publications and source records attributed to G Rozzio.
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An assessment was made of environmental micro-organisms isolated in the University of Turin Intensive Surgical Care Unit and Emergency Surgery Department to determine the possible exogenous origin of post-operative infections. The enzymatic characters and antibiotypes were determined for some species, and subsequently compared with similar characters of the "in vivo" isolated flora. A monthly disinfection method based on comparison among three antiseptic agents (chlorexidine, formaldehyde and formotetronium) considerably reduced the flora. The data obtained, while showing that most of the infections observed were endogenous, also provided indications on the way in which the spread of certain Gram-negative germs, often involved in post-operative and post-traumatic infections, could be contained.
Considerations of a physiopathological nature are expressed with regard to haemorrhagic multiple-injury patients in the light of the experience acquired in first-aid practice at the University of Turin department of emergency surgery. While treatment of the basic injury is the key to therapy, sufficient infusion management and careful monitoring of coagulation parameters before and during transfusion may be of fundamental importance in survival. By the same token, not all blood products available can be used indiscriminately. A treatment and monitoring protocol for the reinstatement of volaemia and corpuscle mass, and for the correction of coagulopathy due to loss, consumption and wash-out is proposed.
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The clinical and bacterial efficiency of tobramycin sulphate administered once a day (150 mg/day) in the prevention of pleural cavity and bladder infections was evaluated by considering 30 surgical patients fitted with thoracostomic tubes or bladder catheters. Pleural cavity sterility was maintained in 74% of cases and bladder sterility was maintained or obtained in 100% of cases. These results confirm the success of the treatment.
The large amount of data resulting from arterial and venous HGA's and analysis of expired gases carried out during the monitoring of critical surgical patients has been statistically reduced to only seven parameters. Personal Mini Computer software able to quantify or predict the necessity for mechanical ventilatory assistance in individual cases has been developed on the basis of the 7 parameters. The system, presently used only as a check, has been found very reliable. Two cases are reported in order to illustrate its use in intensive treatment.
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After wide preface about peritoneal anatomy, pathological, physiology and physiopatology and about the physiopatology of general acute peritonitis, a case records of 61 patients is produced. All the patients were shocked and urgently operated for general acute septic peritonitis and were abundantly washed with a polisaline solution during the operation. That washing technique is described and the authors remark its abundancy (at least 10-12 litres) and its systematicity. They also remark that the washing is the true and main moment of the reanimation and it is the most important salvage action in the general acute peritonitis. The antibiotical therapy, especially the topical one, and the drainage are only complementary elements in the treatment. Among 61 patients, with an average of 54 years, there were eight deaths (13%) in old patients, with an average of 71 years and they were all caused by cardiac and circulatory disease. No patient died for peritonitis or for toxic-infections causes. The postoperative morbility (eight patients-13%) was mainly caused by the infection of the laparotomy and it only prolonged some days the stay in hospital.
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