Scand J Surg
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Penetrating injuries to the chest present a frequent and challenging problem. The majority of these injuries can be managed non-operatively. The selection of patients for operation or observation can be made by clinical examination and appropriate investigations. ⋯ Minimally invasive techniques have found sound application in the thoracoscopic evacuation of undrained hemothorax and the laparoscopic evaluation of diaphragmatic trauma. In the operative arena, lung-sparing techniques with the use of staplers, like wedge resection and tractotomy, have allowed easier, faster, and effective control of bleeding without sacrificing unnecessarily normal pulmonary parenchyma. Knowledge of the new advancements in the field of thoracic trauma will allow surgeons to provide expert care and improved outcomes.
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The aim of this retrospective study was to analyze retention in cast after closed reduction of low-energy two-fragment tibial shaft fractures. ⋯ Closed reduction and cast treatment of spiral tibial shaft fractures AO/ ASIF type A1.2 had a high failure rate.
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The early severity assessment of an attack of acute pancreatitis is clinically of utmost importance. The aim of the present work was to study the role of leucocyte count and C-reactive protein (CRP) measurements on admission to hospital in assessing the severity of an attack of acute pancreatitis. In particular, patients with a life-threatening attack of acute pancreatitis but a normal leucocyte count and CRP level were sought. ⋯ It is very unlikely that acute pancreatitis proves to be a life-threatening one when both the leucocyte count and CRP are normal on admission to hospital. In the present 1050 acute pancreatitis there were no patients with life-threatening disease but normal laboratory values on admission.
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Historically, penetrating abdominal trauma was managed expectantly until the late 19th century. In World War I, with the high mortality and morbidity associated with penetrating abdominal trauma, operative management replaced expectant management. It was soon realized that not all penetrating abdominal injuries required an operation. ⋯ However, gunshot wounds to the abdomen are still treated by mandatory exploration based on an allegedly high incidence of intra-abdominal injuries and low rate of complications, if laparotomy turns out negative. A number of series have recently surfaced, reporting successful outcomes, while decreasing morbidity and hospital length of stay, with selective non-operative management of gunshot wounds to the abdomen. This review will address the current controversies surrounding selective nonoperative management of gunshot wounds to the abdomen and will present our experience and current approaches.
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Colonic or rectal injuries occur in up to 10% of patients that suffer penetrating or severe blunt abdominal trauma. The majority of colon injuries are diagnosed intraoperatively following a penetrating abdominal injury. ⋯ The vast majority of colon injuries can be primarily repaired with a significant trend toward avoiding colostomy whenever possible. Colostomy is increasingly reserved for rectal injuries and destructive colon injuries with extenuating circumstances such as hemodynamic instability and significant associated injuries.