The Australian and New Zealand journal of surgery
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A team approach to the initial assessment, investigation and management of potentially seriously injured patients has been instituted. Team members are alerted through an emergency paging system which is activated when a patient fulfills one of a predetermined list of criteria relating to the injury incident, physiological status of the patients and anatomic injuries. Medical members of the team include surgical, intensive care, anaesthetic, and accident and emergency staff. ⋯ Although a false alarm rate of 46% is higher than desirable, the number of calls per day would still only average 2 in a hospital with a high trauma patient load. The checklist criteria were highly sensitive (97%) in identifying those patients who should have been evaluated by the trauma team. Although hospitals differ in workload and staffing, this trauma team model is recommended for more widespread use and for further evaluation and modification.
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The total leucocyte count (TLC) and neutrophil percentage (NP) were studied prospectively in 1032 patients who underwent appendicectomy for suspected acute appendicitis. On histopathological study of the resected appendices, 97 patients had normal appendices, and 935 patients had acutely inflamed, gangrenous or perforated appendicitis. Statistically more patients with appendicitis had either raised TLC or raised NP compared with patients with normal appendices (P less than 0.001), and also compared with 357 patients who were admitted with right lower quadrant abdominal pain but were not subjected to operation (P less than 0.001). ⋯ In contrast, sensitivity decreased when both raised TLC and raised NP were used together, but specificity increased. Raised TLC, preferably combined with raised NP, is a useful diagnostic aid in acute appendicitis. The TLC and NP, however, should only be interpreted in the light of physical findings in patients with suspected appendicitis because these blood tests have false positive and false negative results.
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A 50 year old man presented with scrotal pain of 2 weeks' duration. The finding of acute appendicitis as a scrotal abscess due to perforated appendix in an inguinal hernia is rare, and literature on this finding is reviewed.
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The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty-two (55%) patients had emergency operations for non-resolution of clinical sepsis (25), persistent symptoms or mass (14) and fistula (three). ⋯ Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial procedure.