American journal of surgery
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A series of fifty-one patients who underwent exploratory laparotomy for blunt abdominal trauma is reviewed. Attempts to correlate preoperative serum amylase levels with pancreatic injury were unsuccessful. ⋯ One must conclude that there is no correlation between elevated serum amylase and pancreatic injury in blunt abdominal trauma. Decisions as to the advisability of operation in patients with such trauma should therefore be based on other parameters.
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Major abdominal vascular injuries present problems in diagnosis, exposure, and management. Combined injuries to the abdominal aorta and vena cava are particularly lethal due to extensive blood loss, difficulty in sequential exposure, and the high incidence of associated injuries. Between 1953 and December 1974, ninety-one patients required emergency operations for abdominal aortic trauma at our city-county charity hospital. ⋯ Sixty-two per cent of the deaths were a function of extreme difficulty in controlling hemorrhage and exposure. There were no late recurrences of arteriovenous fistulas. Successful management of acute traumatic injury to both the abdominal aorta and vena cava requires rapid, aggressive surgical management, adaptive sequential control maneuvers, and application of technics and principles developed for elective vascular surgery.
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Two hundred patients with neck burns were analyzed to determine the incidence of contractures. It was found that only 8 per cent of patients with second degree burns had contractures, all of which were mild. Both the overall incidence of cervical contractures in patients with third degree neck burns and their severity can be decreased by the use of a custom-formed isoprene splint. Splinting should begin as soon as possible after the burn and continue until scar maturation is complete.