The Australian and New Zealand journal of surgery
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Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long-term follow-up in these patients have been sparse. ⋯ Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short- and long-term complications.
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Comparative Study
Adverse events after prostatectomy in Victorian public hospitals.
A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was conducted to analyse trends in prostatectomy rates in Victorian public acute-care hospitals from 1989/90 to 1994/95. The study also sought to identify predictors of adverse events (AE) after prostatectomy, and to compare in-hospital complications between open prostatectomy and transurethral resection of prostate (TURP). ⋯ The rise in AE rate after prostatectomy is unlikely to reflect poor quality of care, because in the same period there was a significant decrease in in-hospital mortality after prostatectomy. A more likely explanation is heightened awareness of AE with a lower threshold for reporting such events. Important factors other than variations in quality of care can result in an increase in AE. Hence the reported increase should be interpreted with caution before attempting to conclude that changes in clinical practice could have a direct impact on these rates.
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This study was undertaken to determine the incidence of preventable trauma death at a non-designated trauma centre in Singapore. ⋯ The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non-trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre-hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.
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Severe truncal multi trauma patients often develop coagulopathy, acidosis and hypothermia that makes major reparative trauma surgery dangerous. It was aimed to try to develop physiological indicators that would predict a poor outcome when conventional reparative surgery was applied. These indicators may help in the decision to switch from conventional reparative surgery to surgery limited to the control of major haemorrhage or organ disruption: so-called 'damage-control' surgery. ⋯ At the above mentioned levels of physiological compromise, patient survival after conventional trauma surgery can be predicted to be very unlikely. Damage-control measures would be worth attempting.
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Oral sodium phosphate has become an attractive alternative to polyethylene glycol for colonic cleansing preparatory to elective colorectal surgery. Its use, however, has been associated with hypokalaemia. The authors of the present study tested the hypothesis that patients with cellular depletion of potassium are at significant risk for hypokalaemia with oral sodium phosphate bowel preparation. ⋯ Caution should be exercised when treating patients with oral sodium phosphate who are considered to be cellularly depleted of potassium. These patients are at risk of hypokalaemia after this treatment.