International journal of surgery
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Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study.
Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain. It may mimic a wide variety of intraabdominal disorders thus frequently leading to delay in treatment, increased morbidity or even in an unnecessary surgery. ⋯ RSH should be considered in the differential diagnosis of the elderly patients under anticoagulation therapy presenting with acute abdominal pain and a palpable mass. CT is the diagnostic modality of choice. Conservative treatment is feasible in most cases. Early diagnosis is mandatory in order to avoid morbidity or unnecessary surgery. In order to prevent a traumatic RSH, trocar insertion under direct vision during laparoscopic surgery and careful attention in the abdominal administration of LMWH are essential.
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Mortality and morbidity in trauma remain a major problem in developing countries. Organized emergency response systems for transfer of trauma patients to hospitals are absent and the consequent delays could cause significant complications. ⋯ Transfer and delay in admission to a tertiary care center does not affect in-hospital mortality of trauma patients in a setting with no emergency response system. This may be due to self selection of patients who survive long enough to reach the hospital.
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The aim of this study was to assess the role of adding gabapentin (Neurontin) to the prescription of patients with opiate resistant pain as a result of critical limb ischaemia (CLI). ⋯ The study has demonstrated that gabapentin is a useful adjuvant in the management of CLI and leads to significant reductions in pain scores and improves night pain for most patients.
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The effect of vasopressors on the healing of gastrointestinal anastomoses is still controversial. The purpose of our study was to research the relationship between dose of dopamine, which is used generally as a vasopressor in shock status, and anastomotic leak in colonic surgery. ⋯ Although vasopressors appeared to increase the risk of anastomotic leakage as a result of splanchnic vasoconstriction, deterioration of microcirculation, and local hypoxia, we found that BPA were increased with high doses of vasopressor. We speculated that the use of vasopressors without shock might increase blood supply to the anastomotic line by increasing cardiac output.