Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Covering soft-tissue injuries on the lower third of the leg, ankle joint and on the calcaneal part of the foot has so far been the domain for free flap use. The distally based superficial sural artery flap with vascular axis of the sural nerve was first described by Masquelet. We treated 31 patients after injuries with this method. ⋯ Most flaps showed slight venous congestion. The authors present their clinical experience using this technique. The advantages are the following: the blood supply is reliable, elevation is easy and quick and major arteries are not sacrified.
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Comparative Study
[The role of CT for indicating laparotomy in blunt abdominal trauma: comparing CT results and surgical findings in a group of 101 patients. Prospective study].
The helical contrast CT plays an important role in the management of abdominal trauma. For surgeons its reliability and utilization remain questionable. ⋯ the study presented high SE of CT forecasting therapeutic laparotomy for blunt abdominal trauma. The high SE of CT in liver and spleen injuries is useful in indicating conservative therapy. The CT accuracy was not confirmed in bowel. mesenteric or diaphragm injury. It strongly recommend patient observation even with negative CT.
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In 513 patients, we investigated residual curarization after general anaesthesia with rocuronium administered, without peroperative neuromuscular blockade monitoring. On admission to the recovery room, the ulnar nerve was stimulated submaximally (30 mA) and the evoked muscle response was quantified with accelerometry (TOF-Watch SX, Organon). ⋯ Compared to the group with adequate recovery, these patients received larger rocuronium dose [45.4 (SD 13.2) mg vs. 40.4 (SD 14.3) mg, p < 0.01], less experienced anaesthesiologists conducted their case [p <0.01], shorter time had elapsed since the last rocuronium dose [58.4 (20.9) min. vs. 64.9 (27.2) min., p < 0.05], their core temperature was lower [35.4 (0.6) degrees C vs. 35.8 (0.6) degrees C, p < 0.011 and on average, they received less neostigmine during anaesthesia [0.26 (0.47) mg vs. 0.57 (0.71) mg, p < 0.01]. We conclude that it is necessary to antagonize residual block after rocuronium, especially in the absence of perioperative neuromuscular monitoring.
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Posterior dislocations are infrequent injuries of the proximal humerus, counting for 1-4% of all shoulder dislocations. Frequently, they are related to epileptic seisures or electric current injuries or accompany complete anatomical neck fractures of the proximal humerus. ⋯ In two cases, transposition of the m. subscapularis was performed, in one case hemiarthroplasty, and in two cases derotation osteotomy of the proximal humerus was used. Although the study group was small, the preliminary results of the procedures for chronic posterior dislocation of the shoulder joint favours preservative procedures compared to hemiarthroplasty of the shoulder joint.
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Up to 50% deaths due to fatal injuries result from thoracic injuries. Approximately 10-15 % of the injuries require thoracotomy. ⋯ The aim of urgent surgical interventions is to manage the major bleeding source (heart or large vascular injury), lungs, air leakage (tracheal or bronchial injuries) and diaphragmatic injuries. Irreversible hypovolemic shock in penetrating thoracic injuries and serious related injuries in blunt traumas resulted in peroperative and postoperative mortality.