Injury
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Comparative Study
A conservative approach to penetrating injuries of the chest. Experience with 131 successive cases.
One hundred and thirty-one cases of penetrating injuries of the chest were reviewed prospectively. A policy of conservative management is advocated, based on the intercostal drainage of moderate or large collections of fluid and/or air. The site of the intercostal drain is not an important factor in the management.
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Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. ⋯ Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. Lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.
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The control of massive haemorrhage in major hepatic injury with caval damage is extremely difficult. Our experience with 5 such patients is reported. ⋯ In 3 patients control was obtained and repair effected without recourse to internal caval shunting. One of these patients survived in spite of extensive injuries.
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The personal experience of a general practitioner who sustained a fracture-dislocation of the atlanto-axial joint is recorded. The inefficient application of an unyielding (non-inertial) lap and diagonal seat belt permitted this injury, although one does not know what other injuries might have occurred had the belt not been worn.
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Isolated injuries of the small bowel mesentery or mesocolon with subsequent bowel infarction due to blunt abdominal trauma are rare. Two cases are described: 1 involving the mesentery to the terminal ileum and 1 involving the transverse mesocolon and middle colic artery, both with bowel infarction. The modes of clinical presentation and management of patients with injuries to the mesentery, mesocolon and mesenteric vessels following blunt trauma are described.