Int Surg
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Comparative Study
Comparison of hepatic abscess after operative and nonoperative management of isolated blunt liver trauma.
Hepatic abscess has been well recognized as a complication after blunt hepatic injuries. The clinical presentation of hepatic abscess after the operative and nonoperative management of isolated blunt liver injury is compared in this study. From 1995 to 2000, 674 patients with blunt liver injury were admitted and were managed either operatively or nonoperatively. ⋯ The formation of abscess occurred within 12 days after admission in the group 1 patients but ranged from 5 days to 6 years in the group 2 patients. One of the group 1 and eight of the group 2 patients had recurrent abscesses and required repeated admission. The nonoperative management of blunt hepatic trauma had a better outcome than the operative approach in terms of a significant decrease in abdominal infections and tended to result in complete recovery without the need of repeated admission and drainage.
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Immediate breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap after skin-sparing mastectomy is becoming an increasingly performed procedure in patients with ductal carcinoma in situ, early invasive breast cancer, and prophylactic mastectomy. Through a periareolar approach, it is possible to remove the breast parenchyma along with the nipple areola complex, preserving almost all the original skin envelope and the inframmamary fold. The TRAM flap is used to recreate the volume and shape of the original breast. ⋯ All reconstruction was considered very satisfactory from an aesthetic perspective by the surgeon and the patient. The nicer aesthetic result with oncological safety is achieved with immediate breast reconstruction with the TRAM flap after skin-sparing mastectomy. The risk of local recurrence is not higher compared with more radical surgical techniques.
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In recent years, there has been a major increase in patients with penetrating injuries to the neck admitted to the Johannesburg Hospital. Pressure on resources led to increasing delays for surgery, and a policy of selective conservatism emerged. In common with other centers, mandatory exploration of all wounds that breach the platysma was found to be no longer necessary as it became clear that many penetrating wounds to the neck were best treated conservatively. ⋯ A retrospective study was made of all patients undergoing exploration for gunshot wounds or stabs to the neck at the Johannesburg Hospital Trauma Unit between 1994 and 1998. An overall mortality rate of 9% was mostly a reflection of severe, associated injuries. The evolution of the nonoperative management of cervical penetrating wounds is a good example of the validity of the concept of "selective conservatism." A distillation of the experience at a busy, urban trauma center is presented, with guidelines to manage these potentially lethal injuries.
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Case Reports
Cardiac herniation mimics cardiac tamponade in blunt trauma. Must early resuscitative thoracotomy be done?
Blunt rupture of the pericardium is a rare injury. Strangulated cardiac hernia following blunt trauma is one cause of reversible cardiac arrest. ⋯ We report here two cases of blunt trauma. Both patients arrived alive in the emergency room and presented signs of cardiac tamponade caused by pericardial rupture.
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Schistosomiasis mansoni is a widespread parasitic disease in the Brazilian territory that affects over 8 million individuals. Hepatosplenic schistosomiasis is a serious clinical presentation of this disease, associated with splenomegaly, liver fibrosis, and portal hypertension, and is responsible for approximately 7% of schistosomotic patients. The surgical treatment of portal hypertension in schistosomotic patients has distinct features when compared with cirrhotic patients, mostly because hepatic function is preserved in schistosomotic liver disease. ⋯ Periportal fibrosis staging revealed that patients with class II or III liver fibrosis had a significant increased risk of recurrent GI bleeding when compared with patients with class I liver fibrosis. Despite the elevation on alanine aminotransferase (ALT) and aspartate aminotransferase (AST), most other liver function tests showed no alteration or were corrected after surgery. We conclude that splenectomy, division of the left gastric vein, devascularization of great gastric curvature, and postoperative endoscopic variceal sclerosis showed good results globally and should be considered as therapeutic options in the treatment of hepatosplenic schistosomiasis.