Surgery, gynecology & obstetrics
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Peritoneal lavages performed in 161 patients who had sustained blunt (93 per cent) and penetrating (7 per cent) trauma were prospectively studied in order to assess our indications and technique, as well as to document the accuracy and complication rate in the hands of an Advanced Trauma Life Support trained resident staff. The most common indication for the performance of a lavage was blunt trauma to the abdomen associated with an altered mental status due to injury to the head or substance abuse. The semiopen technique was used 91.0 per cent of the time with a complication rate of 0.6 per cent. ⋯ Computerized tomographic scanning may be more useful than peritoneal lavage in the evaluation of patients with pelvic fractures or other retroperitoneal injuries which often result in false-positive lavage. Peritoneal lavage is often an inaccurate indicator of isolated intestine and diaphragmatic or retroperitoneal injury. Given its simplicity, low complication rate and accuracy, peritoneal lavage can be safely performed by surgeons in training to evaluate the victim of trauma.
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Fifty consecutive outpatients with bleeding internal hemorrhoids were prospectively treated with a single application of rubber band ligation or infrared coagulation. Complete follow-up observation was obtained in 48 patients (23 underwent rubber band ligation and 25 underwent infrared coagulation). At one month after treatment, 22 patients who underwent rubber band ligation and 16 who underwent infrared coagulation, were symptomatically improved (p less than 0.05). ⋯ There was no statistical difference in the discomfort experienced by either group during or after the procedure as determined by a self-assessment scale. Two patients who underwent rubber band ligation experienced complications--a thrombosed external hemorrhoid developed in one patient and another had delayed rectal bleeding. Although associated with occasional complications after treatment, rubber band ligation is more effective than in infrared coagulation for single session treatment of bleeding internal hemorrhoids.