The American surgeon
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Accounting for each wounding bullet represents an important part of the emergency room evaluation of gunshot victims. Physical examination must include a thorough search for exit wounds. Medical personnel must be aware of the possibility of intra-arterial passage of a wounding missile and routinely obtain appropriate roentgenagraphic studies so that patients with arterial bullet embolization will be identified preoperatively and can receive optimal surgical repair of their injuries.
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One hundred radial-cephalic fistulas were surgically created for hemodialysis between April 1970 and September 1973. A side-to-end anastomosis was constructed in 86 per cent of cases. ⋯ Blood vessel quality and surgical technique are the most important factors in achieving a low failure rate. Use of the fistula for early hemodialysis has not been associated with complications and is advocated.
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The diagnosis and management of 76 patients with pancreatic trauma is reviewed. There was an overall mortality rate of 5 per cent. A preoperative serum amylase determination was a valuable parameter when assessing blunt trauma. ⋯ Interruption of ductal integrity accounted for 47 per cent of all complications. Only one-third required reoperative therapy. Associated major vascular injuries accounted for all deaths.
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Seven case reports of ingested foreign bodies are presented. Although ingestion of foreign bodies may be a frequent occurrence, 80 per cent of documented ingested foreign bodies pass through the gastrointestinal tract spontaneously. The most frequent victims of foreign body ingestion are children, denture-wearing adults, and the mentally ill. ⋯ Some require surgical removal because of perforation hemorrhage or obstruction. The ileocecal region is the most common site for perforation. Close observation for signs of perforation, hemorrhage, and/or obstruction is mandatory.