Int Surg
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Over 21,000 patients with symptomatic hemorrhoids were treated either at the Rudd Clinic in Toronto, or at Proctology International in the Cayman Islands, with the ligation or the ligation and cryosurgical technique. The procedures as described are simple, very effective and should be done in the office and not in the hospital. It is better for both patient and doctor and the cost saving is in the tens of millions of dollars in our series alone. ⋯ All surgeons are encouraged to adopt new techniques which will improve the treatment of their patients and their own reputation. It is a changing world--especially in medicine and we must keep up and be willing to adapt. I recommend the ligation and cryosurgical technique to all surgeons for the treatment of all symptomatic patients with hemorrhoids.
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Data from Trinidad and Tobago suggest there is a positive role for the ATLS program in Third World countries. Between 1970-1979 traffic accidents increased from 16,433 to 28,003 while deaths increased from 179 to 252 per year. Sixty-nine per cent of deaths were adult males mainly between 20-30 years old and most fatal accidents occurred between 6:00 and 10:00 p.m. particularly on weekends. ⋯ Accordingly, 75% of trauma deaths occur in hospital with 65% of those dying within six hours of reaching the hospital alive. Compared to a similar sized North American population the death to injury ratio is at least doubled. The beneficial impact of the ATLS program in Third World countries is assured if ATLS quality control is maintained and can be assessed, as outlined, by comparing pre ATLS with post ATLS data.
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On the fifth postoperative day after pulmonary lobectomy, a 64-year-old man accidentally connected his nasal catheter (providing six liters of oxygen per minute) to his nasogastric tube. Tension pneumoperitoneum occurred with acute respiratory distress. ⋯ Our case illustrates another unusual cause of tension pneumoperitoneum. Emergency percutaneous decompression was effected with needle aspiration, followed by laparotomy for gastric repair covered by an omental flap.
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The authors discuss the indications for emergency carotid endarterectomy, based on their experience between 1956 and 1975 when 15 patients with completed stroke and internal carotid occlusion (Group I) underwent this operation, and after 1975 when emergency revascularization was performed in 22 patients with unstable neurological deficit (Group II) and 21 patients with TIA's associated with preocclusive internal carotid stenosis (Group III). The good early and late results show that surgery was indicated in these cases. An attempt to identify the patients at high risk of acute ischemia on the basis of clinical or anatomical findings is made to ascertain the physiopathologic patterns of cerebral ischemia.