The Australian and New Zealand journal of surgery
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During the period from May 1992 until April 1993, 108 patients were admitted to Liverpool Hospital with Injury Severity Scores (ISS) > 15. Temperatures had been recorded in 100. Of these, 17 had a core temperature of less than 35 degrees C documented within 24 h of arrival. ⋯ When injuries were ranked by ISS, both hypothermic and normothermic patients were equally likely to have received a blood transfusion; however, the mean number of units of packed cells transfused was greater for the hypothermic group with ISS < 41 than for the similarly injured normothermic group. Two patients in the hypothermic group had sustained burns, and both of these were hypothermic on arrival. All of the hypothermic patients who required surgery developed hypothermia in the operating theatre.
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New justification for the use of regional anaesthesia, either alone or in combination with general anaesthesia, has been provided with reports of some unexpected influences on outcome. A reduction in the incidence of postoperative thrombotic episodes and vascular graft occlusion is strongly suggested in patients with generalized vascular disease. Application of a variety of drugs, including local anaesthetics, opioids and adrenergic agonists, in the region of the spinal cord reduces afferent input during surgery and also the metabolic stress response. ⋯ Premedication with opioid and other analgesics may also enhance this pre-emptive effect. New general anaesthetic and analgesic drugs are available that are more suited to these combined techniques. They have shorter duration of action so that plasma concentration can be rapidly adjusted to match a variable surgical stimulus.
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An unusual case of a traumatic dorsal transscaphoid perilunate dislocation occurring through an isolated scaphoid non-union is presented. This set of circumstances has not, to the authors' knowledge, been described previously.
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Comparative Study Clinical Trial
Laparoscopic versus open appendicectomy for suspected appendicitis: a prospective study.
Despite recent advances in minimally invasive surgery, laparoscopic appendicectomy has been questioned as a feasible method of treating patients with suspected appendicitis because open appendicectomy carries few risks and complications. Between February 1992 and January 1993 a non-randomized prospective study comparing open and laparoscopic appendicectomy was designed to assess differences in postoperative morbidity, pain, inpatient hospital stay and a return to normal lifestyle. One hundred and sixty-seven patients with suspected clinical appendicitis were assigned to open (n = 74) or laparoscopic (n = 93) appendicectomy. ⋯ There was a significant reduction in both postoperative inpatient stay (P < 0.0001) and time taken to return to work or normal activities (P < 0.0001) for the laparoscopic group. The use of laparoscopy for patients with suspected appendicitis aids definitive diagnosis and should reduce the negative appendicectomy rate to an acceptable figure. The results suggest that laparoscopic appendicectomy is safe and offers advantages over open appendicectomy in the management of patients with suspected appendicitis.