American journal of surgery
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A retrospective study was carried out in nine children between the ages of 10 and 20 years with adenocarcinoma of the colon. No family history, significant medical history, or predisposing factors were identified, except for Turcot's syndrome in one child. Common presenting signs and symptoms were vague abdominal pain, nausea and vomiting, weight loss, change in bowel habits, and guaiac-positive stools. ⋯ Their median survival was 4 months compared with 24 months in the four patients diagnosed early. As with adults, the mainstay of therapy is operation. Our data indicate that an increased awareness and consideration of colon cancer in children will result in earlier diagnosis, a more favorable disease stage, and prolonged survival.
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Over a 9-year period, fasciotomy for presumed compartmental syndromes after trauma was performed in 25 upper extremities and 100 lower extremities in 122 patients. This procedure was most commonly indicated after vascular injuries in the lower extremities. Twenty percent of patients underwent fasciotomy before vascular repair. ⋯ Seventy-five percent of amputations in the lower extremities were related to a delay in performing fasciotomy or an incomplete fasciotomy. Upper-extremity fasciotomies most commonly did not decompress the deep component of the volar compartment, whereas lower extremity fasciotomies without fibulectomy most commonly decompressed all four below-knee compartments. Fasciotomy sites were closed by direct suture in more than half of the patients.
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The charts of 38 patients managed with a period of intensive medical treatment (mean 7 days) prior to portosystemic shunting were examined. We found that the operative delay did not improve the Child's class or the indices of liver function. The operative mortality rates in these patients were 0 in Child's A patients, 13 percent in Child's B patients, and 50 percent in Child's C patients. ⋯ The charts of 10 consecutive Child's C patients operated on without a period of intensive medical management (mean 3 days) were reviewed and compared with the charts of 8 Child's C patients with delayed operation. The two groups of patients were similar. We recommend that patients who need a shunt should be operated on as soon as possible after bleeding has ceased.