Acta Chir Belg
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Despite major advances, pitfalls in diagnosis and emergency treatment influence the survival chances of multitraumatized patients considerably. Diagnosis of traumatic shock cannot be made by blood pressure, pulse rate and shock index. Immediate shock therapy is indicated in all cases with severe trauma of two body regions, combined injury of one body cavity and long bone fractures and in all cases with one major thoracic or pelvic injury. ⋯ Operating time can be reduced considerably by 2 surgical teams operating simultaneously or overlapping. Early shock diagnosis, immediate intubation, ventilator treatment and the "4-stages-schedule" are considered the most successful steps in the management of multitrauma, as well as volume replacement with Fox' hypertonic saline solution and blood constituents instead of colloids. This has reduced mortality due to respiratory failure from 31% to 20%.
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Short foot syndrome, a form of Volkmann contracture is a not so rare complication after fractures of the lower leg. Retrospectively we found this complication in 5.1% of our patients. This severe complication is prevented by early fasciotomy for decompression of tissues. ⋯ In this period we saw only one patient with late sequellae of compartment syndrome. The technique of fasciotomy of all 4 compartments by one parafibular incision is described. Morbidity and postoperative complications are minor.
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Of the 157 cases of chest injuries, 41 patients underwent thoracotomy. Thirty-three were male and 7 female with an average age of 27 years. Eighty-three percent had stabwounds and 17 percent gunshotwounds. ⋯ The only patient who died in our series suffered from septicemia after multiple associated intra-abdominal wounds (mortality rate 2.4%). The overall complication rate was 19.7%. The average period of hospitalisation was 15.4 days.
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From a series of 58 cholecystectomies for chronic cholecystitis or for asymptomatic cholelithiasis, the authors have retrieved: 1) gall microbial contamination in 15,5% of the samples under study; 2) a complicated evolution--according to criteria defined for this research--of the operative wounds in 37,5% of the cases with positive gall cultures, and in 11% when the gall was sterile. It is the authors' opinion that cholecystectomy shows an actual septic risk, even in a non-acute clinical stage.