Surgical cautery revisited

A new hemostatic scalpel has been developed to control bleeding between the cut edges of wound tissue. The scalpel blade resembles conventional scalpel blades, except that it can be heated and its temperature controlled within narrow limits. Cutting is accomplished by the blade's sharp edges, and hemostasis results from the direct transfer of heat from the blade to the tissue. This experimental study has demonstrated that the hemostatic effect of the scalpel is associated with damage to the tissue's defenses against infection and impaired wound healing.     

Cardiac rehabilitation following coronary artery bypass surgery

Early expectations of coronary revascularization prolonging life and reducing coronary events have been modified by 15 years' experience to mostly initial palliation of ischemic symptoms. Bypass surgery represents only a single therapeutic aspect for coronary atherosclerosis. Technically successful operations often fail miserably without overall risk factor alteration and functional capacity optimization which progressive exercise initiates during the postoperative period. Regular activity program participation improves physical conditioning, raises the symptom-limited exertional level, lessens post surgical musculoskeletal discomfort, and improves morale. Yet exercise alone without comprehensive secondary prevention and risk factor modification will be no more successful at arresting atherosclerosis than any other single measure. Both operative intervention and vigorous exertion are valuable components of coronary artery disease therapy, but must be part of an all-embracing effort. Whether regular exertion combined with overall risk factor modification will prolong life and reduce future cardiac events or beneficially alter the process of atherogenesis remain areas of avid investigation.     

Experimental Endocarditis in Calf after Tricuspid Valve Replacement

A calf model for reproducible, prosthetic tricuspid valve endocarditis was developed using Staphylococcus aureus. The course of late prosthetic valve endocarditis was characterized as a fulminant disease when untreated with antibiotics. The earliest sign of a colonized valve prosthesis was an elevation of body temperature, which correlated with occurrence of positive blood cultures. The dose required to colonize an endothelialized tricuspid prosthetic valve in the calf model was 10⁷ to 10⁸S. aureus organisms. In the model for late prosthetic valve endocarditis, silver-allantoin-heparin (SAH) treatment of the prosthetic valve gave no protection from inoculums of 10⁸S. aureus injected 60 days after operation. SAH treatment may be beneficial in early stages of prosthetic valve endocarditis, but this requires further study. Simultaneous cultures from the right atrium, the right ventricle, and the aorta of 2 animals showed that there was a 1,000- to 10,000-fold decrease in the bacterial titers across the combined pulmonary and systemic capillary beds. Bacterial titers drawn from the jugular vein had a 46% false negative result, and positive cultures from the external jugular vein showed only 1.3 S. aureus organisms per milliliter of blood. These bacteriological findings point out the risks of depending on sampling from the peripheral venous system when culturing for right heart endocarditis.     

Thyroid cancer: Some basic considerations

From these data and data from the literature, our recommended treatment for well-differentiated cancer is as follows: For papillary cancer, resection should be adequate to encompass the entire tumor, which in most cases would be complete lobectomy and possibly isthmusectomy. Prophylactic neck dissection is of no value; therapeutic modified neck dissection should be done for stage II disease. Follicular cancer can be treated by lobectomy (for small lesions) or subtotal thyroidectomy. Although total or near-total thyroidectomy may be required in selected patients with large primary cancers or in those with extensive capsular invasion or extrathyroid extension, the number of cases indicating this is small. There were only a few such patients with large primaries requiring total thyroidectomy in this study. Total thyroidectomy is best avoided in most cases, considering the price of hypoparathyroidism and the lack of a significant improvement in survival compared with lesser ablative techniques. Postoperative ablation with iodine-131 did not improve survival in staged patients with papillary cancer (the number of patients with follicular cancer was too small for analysis). Postoperative thyroid suppression by exogenous thyroid hormone postoperatively appeared to improve survival. Although the data were not adequate for evaluation in follicular cancer, there seems to be no reason not to use this postoperatively in high risk patients with either papillary or follicular cancer.     

Polyethylene glycol intoxication in burn patients

Unexplained increases in the anion gaps and serum osmolalities were observed in 3 burn patients who died following treatment with a polyethylene glycol-based burn cream. Toxicity due to absorption of polyethylene glycol was suspected after other causes had been excluded. Ethylene glycol was found in the circulation and the 3 patients died in acute renal failure. All the patients were acidotic with increased anion and osmolat gaps. This syndrome was similar to the more common poisoning with ethylene glycol but also included an increased serum calcium with a concomitant decrease in the ionized calcium. The cause of this high ‘calcium gap’ appeared to be binding of calcium by dicarboxylic acid metabolites of polyethylene glycol. These findings were the same as those found in rabbits treated with polyethylene glycol.     

Epidemiology of minor burn injuries

The incidence of minor burn injuries has been determined for the Commonwealth of Virginia during a 17-month period. The data set included all patients with burn injuries receiving treatment in the emergency department that did not require hospitalization. The risk of burn injury was calculated by age, face and sex. Examination of the data revealed large differences in the magnitude of age-specific incidence rates between men and women and the white and non-white population.

Differences in the economic status of the population may explain a large proportion of the variation in the crude burn rates.