Acta Chir Belg
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Small bowel perforation is a relative infrequent complication of blunt abdominal trauma. We reviewed the literature regarding this clinical entity and describe our experience in 22 patients. There were 17 male and 5 female patients; mean age was 34 years. ⋯ One patient died because of ARDS and inflammatory syndrome; all the other patients had an uneventful postoperative course. It is concluded that peritoneal lavage remains the most appropriate diagnostic approach. In the absence of peritonitis primary closure can be safely done; otherwise tube drainage or anus praeter construction should be performed.
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From 1975 to 1989, 51 patients presenting with hepatocellular carcinoma complicating genetic haemochromatosis were managed in our institution. Twenty-one patients underwent a laparotomy. Laparotomy was limited to surgical exploration or palliation in 8 patients in whom the tumour was deemed unresectable. ⋯ There was one hospital death in the resection group and in the transplant group. Only 3 patients have remained free of tumour recurrence after a mean follow-up of 18 months. Common clinical and histological features for patients with this condition included masculine gender, age 50 years or above, 10 or more years of history of diagnosed genetic haemochromatosis, high alcohol intake, and grade III or IV hepatic fibrosis.
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An inquiry set up in the Flemish- and French-speaking parts of Belgium, shows some deficiencies in surgical training. The training of a general surgeon should not take longer than six years. The first four years should consist in a general training in surgery, the last two years being used for the subspecialization. ⋯ Lectures during working hours are preferable to those given in the evenings. The residents should be allowed to go off duty after a night on duty, this is already standard practice in several European countries. An independent visitation committee, evaluating the departments, their heads and the resident trainees is needed.
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Actual organ transplantation evokes more and more ethical questions. There is scarcity of donor organs. The waiting lists of potential recipients for organ transplantation are steadily growing as is the number of dead among the waiting patients. ⋯ Xenotransplantation is largely under investigation. However, it is out of question that primates, which are threatened already with extinction should act as organ suppliers for mankind. Xenograft organs should be found in animals for food consumption, sufficient in number and more easily accepted as organ donors on ethical ground.
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From 1978 to 1990 inclusive more than 1,200 patients above 70 years of age have been treated surgically for a hip fracture at the University Hospitals of Leuven. Intracapsular fractures were classified as to Garden and extracapsular fractures as to Evans. The physical and mental conditions of the patients at the time of the accident were largely determining the choice of the treatment, a treatment that held quo ad vitam only little risk for the patient and that permitted early weight bearing on the operated limb. ⋯ Nearly all type 1 pertrochanteric fractures can be treated with a (modified) dynamic hip screw technique. Prosthetic surgery is only indicated in very complex type 1d fractures. For type 2 fractures, the gamma-nail is (may be) the best solution.