The British journal of surgery
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Failure to recognize early that penetrating neck wounds include the cervical oesophagus greatly increases morbidity and mortality. From an analysis of experience over 5 years (1978-1983) it emerges that, while tracheal wounds are usually recognized early, cervical oesophageal injuries are not. It is empyema which complicates such oesophageal injury and which prompts referral to a Department of Thoracic Surgery, the patients by this time being mortally ill, with septicaemia and malnutrition. ⋯ Empyema is usually right-sided. Early recognition and prompt referral are associated with a low morbidity and low mortality. Late recognition and late referral carry a high morbidity rate, prolonged convalescence in those who survive, and a mortality rate of nearly 25 per cent.
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Randomized Controlled Trial Clinical Trial
Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial.
The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage ( PTBD ) followed by laparotomy. ⋯ Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD .
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The clinical presentation and management of 102 vascular injuries associated with bone and joint trauma, in 100 patients over a 6-year period, is reviewed. Eighty-three injuries involved the lower limbs. Amputation became necessary in 16 patients. ⋯ The orthopaedic injury should be treated on its merits. In contaminated or comminuted fractures skeletal traction (or in suitable cases exoskeletal fixation) can be employed without adversely affecting the vascular repair. A plea is made for early diagnosis of concomitant vascular injury in patients with bone and joint injuries; this depends on clinical awareness and careful and repeated examination.