The Australian and New Zealand journal of surgery
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This report gives the results of a cost-efficiency analysis of a prospective longitudinal study evaluating two forms of prophylaxis against postoperative pulmonary complications in 876 patients undergoing abdominal surgery. It cost $12.19 per patient for conventional chest physiotherapy, and equivalent costs accrue when incentive spirometers are recycled and used on average 2.3 times (in the Royal Perth Hospital, incentive spirometers are recycled an average of 4.7 times). Maximum cost-containment can be achieved by carefully selecting patients for physical chest care and then instigating a programme of perioperative chest care utilizing recycled incentive spirometers. This approach does not compromise the clinical benefits of prophylactic chest care and allows physiotherapy resources to be directed toward patients with established pulmonary problems.
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Traumatic air embolism is rare in Australia, but must be treated promptly if patients are to survive. A single fatal case of traumatic air embolism due to penetrating trauma is described with attention to the presenting symptoms and signs, the unsuccessful attempts at resuscitation and correlation with the post-mortem findings. ⋯ Early aggressive treatment is therefore necessary for survival. The diagnosis can be missed at post-mortem if not specifically sought.
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The aim of this report is to review recent experience of removal of anatomical segments of the liver. Resection of one or more segments of the liver was undertaken in 49 patients; in 32 patients, the resection was for malignant disease and in the remainder it was for benign disease. ⋯ There was no postoperative or in-hospital mortality. The removal of anatomical segments of the liver is a very useful technique for the safe removal of benign and malignant lesions.
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A case of a young man who developed a Streptococcus milleri liver abscess secondary to an occult colonic foreign body, which presented as fulminant community acquired pneumonia, is reported. The isolation of Streptococcus milleri, a normal member of the gastrointestinal flora, from an abscess, blood or sputum should prompt a search for pathology, foreign bodies or silent perforation in the gastrointestinal tract.
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Randomized Controlled Trial Comparative Study Clinical Trial
The use of taped skin closure in orthopaedic wounds.
The cosmetic result, cost effectiveness, and complication rate of three different types of skin closure: staples, tapes, and interrupted nylon were compared. In 68 wounds, skin closure was randomized to staples, tapes, or interrupted 3/0 nylon sutures. All wounds were closed subcutaneously with interrupted undyed 2/0 dexon. ⋯ Tapes were the most cost-effective because they are the cheapest although they were not as quick to apply as staples. There was no difference in complication rate. Tapes also afforded the greatest patient comfort.