Int Surg
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A retrospective review was performed of 98 patients admitted to a Level I Trauma Center between July 1989 and December 1990 with a diagnosis of blunt chest trauma. Of these patients, 49% suffered either immediate or delayed complications. Immediate complications included hemothorax or pleural effusion in 21.4%, pneumothorax in 36.7%, and ruptured diaphragm in 2%. ⋯ Similarly, 51.8% of patients with ISS < 16 had complications. Statistically, neither TS nor ISS could be used to predict complications, regardless of the reference value chosen for TS or ISS. Therefore, it is imperative that all patients with blunt trauma be considered at risk for secondary complications, even those with "favorable" TS or ISS.
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Fungal endocarditis after cardiac surgery has been noticed increasingly in the past decade. We report a case of Candida parapsilosis endocarditis after mitral valve replacement in a patient with no predisposing factors. In this report we mainly examined the pathological findings in this patient with post-mortem examination.
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Retroperitoneal lymphangioma is an unusual disease, more customarily reported in infants, only occasionally in adults. This paper reports four cases of histologically-confirmed retroperitoneal cystic lymphangiomas detected in adulthood. All four patients presented with palpable abdominal mass. ⋯ Correct preoperative diagnosis was made in only one case, but four tumors were totally excised. Biochemical analysis of the lymphangioma content from three of the patients proved protein and fat rich. The CT attenuation numbers of both serous and chylous lymphangioma were similar and near that of water and so were not helpful in differential diagnosis with other cystic lesions with watery density content.
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A total of 192 AV fistulas were created at the anatomical snuff-box. One hundred and eighty-two (94.8%) of them were patent and ready for use at the end of one month. This fistula has several advantages over the more commonly performed Brescia-Cimino radio cephalic fistula at the distal forearm. Snuff-box fistula is easier to perform, has a better patency rate, fewer wound complications and preserves proximal sites for fistula.
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In 3 years, 26 patients were operated for penetrating heart wounds at our institution, the majority between 30 to 60 minutes after injury. Twenty-two patients with a possible heart wound were immediately taken to the operating room for thoracotomy. One patient initially underwent laparotomy while 2 were observed before operating-room thoracotomy. ⋯ Stab wounds determined the best survival rate: 94%, whereas for gunshot wounds it was only 50%. Our experience at this Brazilian Trauma Center reveals that delay in reaching the hospital selected the patients, that clinical condition on arrival, method of injury (knife or gunshot), emergency room staffed with trauma surgeons and aggressive operating room treatment for penetrating heart wounds results in a remarkable survival rate. Emergency-room thoracotomy should be reserved for patients "in extremis" or when there is no operating room available.