S Afr J Surg
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The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. ⋯ Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations.
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At the turn of the century, a significant advance in the rapidly expanding field of rotational thrombelastography (ROTEG), known at present as thrombelastometry or ROTEM analysis, was developed at the Ludwig-Maximillian University in Munich. The measuring unit is operated by a laptop computer. ⋯ It also provides a useful guide in the choice of an appropriate therapeutic option in the bleeding patient, reducing costs by avoiding administration of costly component therapy such as fresh-frozen plasma, cryoprecipitate, platelet concentrates or antifibrinolytic agents. As well as being useful in monitoring anticoagulant therapy and the use of pharmacological agents, ROTEM is a valuable research tool in the field of hypercoagulability, fibrinolysis, factor XIII activity and the ultimate phases of the blood coagulation process.
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The cancellation of surgery wastes theatre time and creates hardship for patients, who often plan their working and family lives around the proposed operation date. ⋯ Last-minute cancellation of surgery was a significant problem, and appreciation of the usual reasons for cancellations can improve theatre utilisation and avoid inconveniencing patients and their families.
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Case Reports
Missile embolism--pulmonary vein to systemic bullet embolism: a case report and review of the literature.
Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988. Rich et al. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict. To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation.