The Australian and New Zealand journal of surgery
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Spinal subdural haematoma is a rare condition, usually seen in association with lumbar puncture or a bleeding disorder. It carries a high morbidity and mortality, and successful treatment requires prompt surgical intervention. We present a case of mixed spinal subarachnoid and subdural haemorrhage complicating failed spinal anaesthesia combined with anti-coagulation in an elderly woman, together with a review of the literature.
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A 29 year old man presented with heroin overdose and rhabdomyolysis necessitating fasciotomy of the left leg muscle compartments. Early recognition of the syndrome of heroine-induced rhabdomyolysis and compartment syndrome is essential to prevent long-term orthopaedic complications.
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The aim of this study was to assess a newly developed computerized tomography (CT)-based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. ⋯ The 12 patients with CT-proven splenic injuries had a mean injury index of 193.5 +/- 191 (mean +/- s.d.). The 3 patients who failed conservative management had a mean index of 475 +/- 50, compared with an index of 99.5 +/- 100 in the nine managed non-operatively (P less than 0.001). This new CT-based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.
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Eight patients with renal abscess were seen in a 15-year period. The patients' ages ranged from 3 to 15 years with a mean of 6.5 years. Included were 7 female children, five of whom were Aboriginal, and 1 male child. ⋯ In 5 cases the infecting organism was penicillinase-producing Staphylococcus aureus and, in 2 cases, Escherichia coli was isolated. It is concluded that the diagnosis of renal abscess should be considered in patients with a febrile septicaemic illness, particularly in Aboriginal female children. Ultrasonography is recommended as the investigation of choice which can also be used to establish percutaneous drainage, thus avoiding surgery.
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A pilot study of the effectiveness of prehospital triage of trauma patients was carried out in a western Sydney between February and July 1988. Triage guidelines were developed to identify seriously injured persons at the incident site who might warrant admission to a Level 3 Trauma Service Hospital (Trauma Centre), as part of the NSW Department of Health trauma services plan. The study results were based on 64% of ambulance trauma transports for which a triage decision was provided. ⋯ However, 62% of trauma transports triaged 'severe' or 'critical' did not have injuries serious enough to warrant admission to a Level 3 Trauma Service Hospital. Nevertheless, the triage guidelines compared favourably with similar instruments used elsewhere. Based on the performance of the triage guidelines it was concluded that the introduction of a regionalized trauma service in metropolitan NSW with local bypass is possible.