Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Case Reports
[Fixed rotatory subluxation of the atlanto-axial joint in polytrauma patients].
Traumatic atlanto-axial instabilities are rare entities in cervical spine injuries. There may be only subtle abnormal findings by plain radiographs, frequently resulting in a missed or delayed diagnosis. We report a polytraumatized patient with severe maxillofacial injuries, where preliminary radiological studies failed to verify rotatory instability of the atlanto-axial joint. A definite diagnosis was only established by further imaging studies, including CT scan reformations.
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The diffuse angiomatosis of the spleen is a rare splenic proliferation. Spontaneous rupture is the main, potentially lethal complication, found in 25% of cases. The problem with these vascular tumors is preoperative diagnosis, because they are asymptomatic for a long time. ⋯ In the case of rupture, splenectomy is a life-saving procedure. We report on a 56-year-old woman with a spontaneous splenic rupture as the first symptom of diffuse angiomatosis of the spleen. Exceptional features of splenic hemangiomas, causes of spontaneous rupture and the therapy are described.
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A diagnostic scoring system, recently published by Ohmann et al. in this journal, was validated by analyzing the clinicopathological data of a consecutive series of 2,359 patients, admitted for suspicion of acute appendicitis. The results of the scoring system were compared to the results of clinical evaluation by junior (provisional) and senior surgeons (final clinical diagnosis). To assess the diagnostic ability of the score, the accuracy and positive predictive value were defined as the major diagnostic performance parameters; the rate of theoretical negative laparotomies and that of diagnostic errors served as the major procedural performance parameters. ⋯ With regard to the main procedural performance parameter, the score resulted in a significantly smaller number of diagnostic errors than the provisional clinical investigator (P < 0.05, chi 2 test). The results of this study indicate that the diagnostic scoring system might be helpful when experienced investigators or additional diagnostic modalities such as ultrasonography are not available. It may therefore be of value in the preclinical evaluation of patients with suspected acute appendicitis and may be instrumental as a quality control tool and in clinical guidelines.