Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Children with pelvic fractures usually are polytraumatized. Concomitant abdominal and pelvic injuries are not uncommon. Medical records and X-rays of 54 children, in which a pelvic fracture was diagnosed at our institution from 1974-1993, were reviewed. ⋯ There were 7 liver lacerations, 7 splenic injuries, 2 mesenteric tears, 2 kidney injuries and 1 small bowel lesion. Eight children (14.8%) died with 5 of them due to retroperitoneal or/and abdominal bleeding complications. A recent follow-up examination (81.8%) with a mean follow-up of 11.3 years showed that long-term morbidity usually was attributed to pelvic concomitant injuries.
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This report describes a retrospective study concerning 314 patients suffering from acute abdominal pain admitted to the surgical emergency unit of Zürich University Hospital in 1992. Basic diagnostic work-up (history, physical examination, blood tests, sonography and abdominal X-ray) revealed the final diagnosis in 188 patients. Sonography was essential in 77 cases. ⋯ A follow-up examination of these patients 6-18 months later resulted in a final diagnosis of somatic diseases in 8% of cases. This study demonstrated that the basic surgical diagnostics are efficient and reveal the final diagnosis with minimal delay. Abdominal sonography is the most important diagnostic tool in this context and should, therefore, be mastered and employed by the surgeon himself.
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Understanding of peptic ulcer disease has dramatically changed within the last years. Today ulcer disease can be considered as a chronic infection. Based on this new pathophysiological concept treatment policies for ulcer bleeding and perforation have to be revised. ⋯ Because of an effective medical treatment of the ulcer disease with eradication, the operation should be restricted to ulcer excision and ulcer oversewing in bleeding or perforated gastric ulcer and duodenotomy, ulcer ligation and extraluminal ligature in bleeding duodenum ulcer and excision and oversewing with pyloroplasty in perforated duodenal ulcer. More definite surgery is not reasonable and should be avoided. With treatment policies based on early elective operation in high risk groups and medical treatment in the other patients a mortality of 5% or less can be achieved.