Practical and technical considerations in establishing an intraoperative radiation therapy program in the community practice

The Radiation Oncology Center in Sacramento, California, has developed a procedure for establishing an intraoperative radiation therapy facility in a community practice. The logistics pertaining to personnel, equipment, physical measurements, and quality assurance are presented. Particular emphasis is given to the most effective means of acquiring the large quantity of data needed to ensure a program of acceptable quality.     

External Cephalic Version at Term

Summary: The case notes of women with singleton term (37 weeks' gestation and beyond) breech presentation and delivery were retrospectively reviewed. Thirty-two of the 72 women in the study group had attempted external cephalic version at term, with a success rate of 53% (17 women). The Caesarean section rate was significantly lower in the group which had attempted ECV compared to the group which did not.     

Complications of laryngotracheal disruption

Owing to the increased use of automobiles, minibikes, motorcycles and other devices for recreational activities, we are now seeing a growing number of severe head and neck injuries. In this paper we will discuss a rare and often fatal injury of the neck, namely, traumatic laryngotracheal separation. There are isolated reports in the literature of heroic efforts to save the lives of such patients, but little has been said regarding surgical repair of the injury and possible late complications. Seven case reports of laryngotracheal avulsion injuries are presented with emphasis placed on the methods of repair of the acute injury and reconstruction of late complications. The etiology of the injury in all cases was a severe localized blow to the extended neck at the level of the cricoid cartilage. Most patients arrived in the emergency room near death, showing obvious signs of upper airway obstruction. A rapid tracheostomy was responsible for saving their lives. In most cases the avulsed trachea was repaired primarily over an internal stent. Associated laryngeal and cricoid fractures were reduced and immobilized. A thorough exploration of the neck was done in most of these patients, and injury to the recurrent laryngeal nerves was commonly noted. Late sequelae depended on the type and extent of associated injuries, the type of repair performed, and timing of the definitive reconstruction. The most satisfactory results were obtained in patients receiving early reconstruction with the use of an internal stent. Equally as important in determining a favorable result following reconstruction was an accurate preoperative and operative assessmet of the extent of injury. Despite optimal early treatment of the acute injury, some patients will remain disabled either from a compromised airway or a poor voice. Additional surgical intervention is possible in most cases, and the variety of problems encountered taxes the versatility of the surgeon.     

Plasma volume and protein restoration after hemorrhage: role of the left thoracic duct versus transcapillary refilling

Following intravenous administration of RISA in splenectomized dogs, there is a steady semilogarithmic decline in plasma albumin specific activity. Concurrently there is a rapid rise in lymphatic albumin specific activity as assayed from left thoracic duct fistulas. A maximum value is found around 255 minutes after which the albumin specific activities in this lymph decline parallel with the ones in plasma.     

The role of the liver in the development of lactic acidosis in low flow states

The role of the liver in lactate metabolism in an experimental low flow state induced by cardiac tamponade was investigated in dogs.     

Influence of body core temperature on blood loss and transfusion requirements during off-pump coronary artery bypass grafting: a comparison of 3 warming systems

BACKGROUND: The aim of this prospective randomized trial was to evaluate the efficacy of 3 intraoperative warming systems (Warm-Touch, Thermamed SmartCare OP system, and Allon 2001) on maintenance of normothermia and to investigate their effects on perioperative bleeding and transfusion requirements in patients undergoing off-pump coronary artery bypass grafting. METHODS: With institutional approval/patient informed consent, 90 patients presenting for elective multiple off-pump coronary artery bypass grafting were randomly assigned to 1 of the 3 warming systems. Active warming was started after the induction of anesthesia. Perioperative transfusion was based on international guidelines. Body core temperature was recorded every 30 minutes during operation. Perioperative blood loss, autotransfusion, and allogenic transfusions were recorded. Analysis of variance was performed with post hoc Scheffé tests and chi 2 tests. RESULTS: Normothermia could be sufficiently maintained during operation by the Allon 2001 only. Final body core temperature was 34.7 degrees C +/- 0.9 degrees C (Warm-Touch), 35.6 degrees C +/- 0.8 degrees C (Thermamed SmartCare OP), and 36.5 degrees C +/- 0.4 degrees C (Allon 2001; P < .001, Warm-Touch vs Thermamed SmartCare OP, Warm-Touch vs Allon 2001, and Thermamed SmartCare OP vs Allon 2001). Perioperative blood loss was 2683 +/- 1049 mL (Warm-Touch), 2300 +/- 788 mL (Thermamed SmartCare OP), and 1497 +/- 497 mL (Allon 2001; P = .195, Warm-Touch vs Thermamed SmartCare OP; P < .001, Warm-Touch vs Allon 2001; P = .001, Thermamed SmartCare OP vs Allon 2001). Transfusion requirements were 1097 +/- 874 mL (Warm-Touch), 986 +/- 744 mL (Thermamed SmartCare OP), and 431 +/- 387 mL (Allon 2001; P = .838, Warm-Touch vs Thermamed SmartCare OP; P = .003, Warm-Touch vs Allon 2001; P = .013, Thermamed SmartCare OP vs Allon 2001). Free of allogenic transfusion were 15 (51.7%; Warm-Touch), 18 (60%; Thermamed SmartCare OP), and 24 (82.8%; Allon 2001) patients ( P = .037). CONCLUSIONS: The goal of normothermia during off-pump coronary artery bypass grafting was best achieved by the Allon system. With this concept, overall blood loss and transfusion requirements were reduced, hence indicating improved quality of perioperative care.