The Australian and New Zealand journal of surgery
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The potential advantages of laparoscopic surgery for a number of abdominal operations including appendicectomy have been heralded. In this study the aims were to assess prospectively the role of routine diagnostic laparoscopy in the diagnosis of acute appendicitis and determine the efficacy of laparoscopic appendicectomy. Patients with suspected acute appendicitis had diagnostic laparoscopy. ⋯ The median postoperative hospital stay was 2 days. The median time before return to normal activities was 8 days. Diagnostic laparoscopy is a useful diagnostic technique in women with suspected acute appendicitis, as it improves diagnostic accuracy, reduces the negative appendicectomy rate and avoids unnecessary laparotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Closed intratendinous ruptures of flexor tendons are uncommon. Two such cases that occurred within the lumbrical origin are reported. ⋯ Ultrasound examination can also help to localize the site. The role of the lumbrical, extrinsic flexors and trauma in the aetiology of the rupture are discussed.
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A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety-six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas. Fifty-eight cases were managed non-operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. ⋯ Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound. While a negative laparotomy was a relatively safe procedure, non-operative management had the advantages of a shorter hospital stay without wound-related morbidity. Selective non-operative management was found to be a relatively safe approach in this series.
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Comparative Study
Helicopter retrieval of primary trauma patients by a paramedic helicopter service.
All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. ⋯ Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non-intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortality), which was not significantly different from the predicted mortality of 17%.(ABSTRACT TRUNCATED AT 250 WORDS)