Canadian journal of surgery. Journal canadien de chirurgie
-
Comparative Study
Management of spleen injuries in the adult trauma population: a ten-year experience.
Increasing awareness of the postoperative risks associated with splenectomies has led physicians and surgeons to use an alternative nonoperative strategy in handling traumatic spleen injuries. Our primary objective was to compare clinical outcomes between operative and nonoperative managements in adult patients with blunt splenic injuries. The secondary objective was to assess the changes in the patterns of managing splenic injuries in the past 10 years. ⋯ The present study has shown that nonoperative management of blunt spleen trauma has increased over time and has acceptable mortality and complication rates in selected patients. Additional prospective studies are needed to assess the feasibility and safety of nonoperative management in adult spleen injuries. Furthermore, the management of traumatic spleen injuries with respect to associated injuries, such as head injuries or intra-abdominal injuries, needs ongoing evaluation.
-
There is a lack of information from Canadian hospitals on the role of hospital characteristics such as procedure volume and teaching status on the survival of patients who undergo major cancer resection. Therefore, we chose to study these relationships using data from patients treated in Ontario hospitals. ⋯ Increased hospital procedure volume correlated with improved longterm survival for patients in Ontario who underwent some, but not all, cancer resections, whereas hospital teaching status had no significant impact on patient outcomes. Across the province, further regionalization of care may help improve the quality of some cancer procedures.
-
Osteitis pubis is a rare and self-limited condition. Surgery may be necessary in 5%-10% of cases. The outcome after surgery for osteitis pubis is not known. ⋯ Four types of surgical intervention are described: curettage, arthrodesis, wedge resection and wide resection. The elite athletes respond well to curettage. Patients with osteitis pubis following urologic or gynecologic procedures or have a proven infection require surgery in roughly 50% of cases. The third group has an unpredictable outcome.