Canadian journal of surgery. Journal canadien de chirurgie
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From January 1975 to December 1984, 93 patients with penetrating chest wounds were admitted to three hospitals in Regina. Sixty-three percent of the wounds were caused by knives and 34% by firearms. ⋯ Whereas the majority of penetrating wounds to the chest may be treated by observation or thoracostomy alone, a surgical approach is recommended when penetrating injuries are thought to have traversed the mediastinum, because of the high incidence of associated cardiac injuries. In doubtful cases the decision should favour early thoracotomy.
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Comparative Study
Conservative management of renal lacerations in blunt trauma.
Controversy in the treatment of blunt renal trauma is largely focused on immediate surgery versus conservative management for parenchymal lacerations. A retrospective analysis of 133 cases of blunt renal trauma at the Victoria General Hospital in Halifax over a 10-year period revealed 26 cases of renal laceration. The conservative approach to radiologic diagnosis and treatment options is discussed. Our experience confirms a low rate of both nephrectomy and secondary complications using conservative management.
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For several years opioids have been given epidurally with success to control chronic intractable pain. The authors report their 2-year experience with internalization of the epidural catheter and injection port in 18 patients at University Hospital, Saskatoon. In all, 21 devices were used. ⋯ Blockage of the epidural end of the device was the most common mechanical problem, followed by leakage from the port. One patient suffered meningitis after 11 days as a result of subarachnoid placement of the catheter but responded to removal of the device and antibiotic therapy. The authors have been impressed with the excellent pain relief afforded to many of these patients, and their ability to enjoy life free of the sedative effects of other methods of narcotic administration.
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A chart review from 1975 to 1985 at the Toronto Western Hospital identified 16 patients (9 women and 7 men, between the ages of 39 and 83 years) with gastrointestinal phytobezoars. Nine had previously undergone vagotomy and drainage procedures. There were two distinct clinical groups, dependent on the location gastric bezoars presented with chronic burning epigastric pain and nausea and vomiting in addition to anorexia and weight loss. ⋯ The postoperative courses were uncomplicated except for wound infection in one patient. None of the patients with an isolated gastric bezoar required surgery. Three patients were successfully treated with gastric lavage and the others with clear fluid diet.
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Case Reports
Trendelenburg pulmonary embolectomy for cardiac arrest secondary to massive pulmonary embolism.
Cardiac arrest secondary to massive pulmonary embolism is rarely reversible by nonsurgical measures. A patient sustained refractory cardiac arrest and was resuscitated by Trendelenburg pulmonary embolectomy without cardiopulmonary bypass. This report describes the diagnosis and treatment of this 37-year-old man and provides a review of the literature on pulmonary embolectomy for patients in whom cardiac arrest has occurred. Awareness of the feasibility of salvaging patients with cardiac arrest secondary to massive pulmonary embolism may lead to wider application of pulmonary embolectomy when conventional resuscitation is unsuccessful.