Int Surg
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Randomized Controlled Trial Clinical Trial
Drainage after cholecystectomy. A prospective randomized clinical trial.
This prospective clinical study was done to assess the efficacy of postcholecystectomy drainage. A total of 173 cholecystectomized patients were randomized into two groups; group A (86 patients) without drainage and group B (87 patients) with drainage. Group B included two types of patients; B1 (52 patients) with suction drain and B2 (35 patients) with gravity drain. ⋯ There was no significant difference in the rate of wound infection or atelectasis in either group, although there was apparent increase of lung complications and subhepatic collections in Group B1. The average postoperative hospital stay was significantly increased in group B patients. Considering all the parameters of this study, it was found that drainage with gravity was attended with the least morbidity.
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A classification system for ankle fractures was developed. The system was based on 2 general fracture divisions, namely uni-, bi-, and tri-malleolar ankle fractures, and the localisation of the fracture at the level of the fibula. The use of the system in 612 ankle fractures that were surgically treated at the Leuven University Hospital between 1978 and 1988 led to the following conclusions: 1. ⋯ The system was easy workable also for young residents and physiotherapists. 3. It was accessible to repetition, allowing for comparisons between different subjects. 4. Taking into account the type of fracture, the final result could be predicted.
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Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeon faced with this problem. Two such cases and their outcome are presented. The first case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. ⋯ A compilation of other etiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest perforation of a viscus, we advise performing an abdominal tap. If negative, continued observation is advised.
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Records of 345 patients in whom laparatomies were performed because of blunt and penetrating abdominal trauma were reviewed retrospectively with respect to factors affecting mortality. One hundred and twenty-eight patients had blunt abdominal trauma (Group I), 114 patients had gunshot wounds of the abdomen (Group II), and 103 patients had stab wounds of the abdomen (Group III). ⋯ The presence of head trauma especially if accompanied by hypotension in group I, and the presence of chest trauma (hemothorax and/or pneumothorax) and hypotension (less than 90 mmHg) in group II were associated with a high mortality rate (p less than 0.05). Of the two patients who died in group III, one had septic shock due to massive intestinal necrosis and the other had hemorrhagic shock due to multiple organ injury and bleeding from an injured internal thoracic artery as the cause of death.
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A total of 72 patients with penetrating cardiac injuries were treated at Teaching Hospital in Basrah from February 1984 to July 1988. All patients were males, ages ranged between 18-40 years. 67 patients (93%) had sustained shell fragment injuries and 5 patients (6.9%) bullet wounds. 13 patients were unconscious on arrival and had no detectable pulse or cardiac activity and no obtainable blood pressure. Emergency room thoracotomy was employed in these patients. ⋯ Pericardiocentesis was of little value in diagnosis and treatment of cardiac tamponade and was not performed. The right ventricle was the most commonly injured chamber (44.4%). 56 patients (77.8%) presented with a normal sinus rhythm and 3 patients (4%) had an idioventricular rhythm. Patients with disorganised cardiac rhythm had a higher mortality (87%), than those with normal sinus rhythm (15%).