Int Surg
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We aim to determine the profile and determinants of outcome of pediatric abdominal surgical emergencies in southeastern Nigeria. We prospectively analyzed 115 children with abdominal surgical emergencies managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria, from January 2008 to June 2009. The emergencies were typhoid intestinal perforation (TIP) 22 (19.1%), intussusception 20 (17.4%), obstructed hernia 17 (14.8%), neonatal intestinal obstruction 11 (9.6%), appendicitis 11 (9.6%), trauma 8 (6.9%), ruptured omphalocele/gastroschisis 8 (6.9%), Hirschsprung's disease 7 (6.1%), adhesive bowel obstruction 7 (6.1%), and malrotation 4 (3.5%). ⋯ Delayed presentation and lack of neonatal and pediatric intensive care facilities were daunting challenges. A pediatric abdominal surgical emergency in our setting has high morbidity and mortality. Efforts geared towards improvement in time to diagnosis and perioperative care may result in better outcomes.
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Hemosuccus pancreaticus is a rare complication of chronic pancreatitis. It is defined as hemorrhage from the papilla of Vater via the pancreatic duct. A 77-year-old man presented with a history of intermittent episodes of hematemesis and abdominal pain. ⋯ Microscopic examination revealed a true aneurysm of the splenic artery. Interventional radiology is commonly performed for diagnosis and treatment, but arterial embolization has a high recurrence rate. Thus, surgery is still required for hemosuccus pancreaticus.
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The purpose of this study was to clarify the rate and characteristics of conscious disorder without intracranial hemorrhagic injury in polytrauma patients. The medical records of polytrauma patients with conscious disorder without intracranial hemorrhagic injury were reviewed. Fifty-five patients (35.3% of 156 polytrauma patients with conscious disorder) were enrolled. ⋯ Conscious disorder due to alcohol was likely seen in patients whose GCS scores were 13 and 14. The rate of conscious disorder without intracranial hemorrhagic injury was high among polytrauma patients. We could not differentiate the pattern of conscious disorder in polytrauma patients without intracranial hemorrhagic injury from that seen in polytrauma patients with intracranial hemorrhagic injury.
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Recent investigations have shown the significance of subarachnoid bleeding on computed tomography scans first taken after admission for head injuries. In our study, we describe a prospective follow-up of 121 patients with traumatic subarachnoid hemorrhage (tSAH). From January 2004 to January 2007 we collected data prospectively from 121 patients admitted with diagnosis of tSAH to our trauma intensive care unit, on the basis of admission with a computed tomography scan. ⋯ The mortality rate was proportionally greater in patients who had cisternal clots >1 mm (P < 0.001), assessed by the Fisher scale with modification. When functional recovery was evaluated using the GOS, the recovery rate and the daily life activities were lower in patients with intraventricular bleeding (P = 0.001). Our results showed that patients with severe tSAH had the worst prognosis.
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Randomized Controlled Trial
Effectiveness of multiple neurectomies to prevent chronic groin pain after tension-free hernia repair.
The question of which nerve--the ilioinguinal or the iliohypogastric--most often causes chronic groin pain after hernia repair remains to be answered. We sought to evaluate the effects of prophylactic neurectomies on the incidence of persistent groin pain after Lichtenstein repair. Two hundred forty patients were randomized to 1 of 4 groups: the all-nerve preservation group, the ilioinguinal neurectomy group, the iliohypogastric neurectomy group, and the neurectomies group. ⋯ No statistically significant differences in quality of life were noted in any of the groups. In conclusion, both nerves seem to be responsible for neuropathic postherniorrhaphy pain. Elective excision of the nerves can be done safely during tension-free hernia repair.