The Australian and New Zealand journal of surgery
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Cavernous haemangioma of the colon is a rare cause of colonic varices. It is a congenital vascular malformation of the large bowel often associated with cutaneous haemangiomata. A case is reported with this unusual pathology presenting with lower gastrointestinal bleeding.
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Three cases are reported in which gastric rupture occurred during cardiopulmonary resuscitation. Precipitating factors are considered and discussed with reference to the literature. ⋯ Its occurrence greatly adds to the morbidity and mortality of the underlying disease. Possible precautions to limit its occurrence are discussed.
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A series of 97 patients has been studied who were treated for liver injury at Westmead Hospital between January 1979 and January 1985. Patients were noted to be younger than those reported in previous series from Sydney, and to have suffered more frequent, significant, head injuries. Paramedical roadside intervention probably allowed more patients to reach hospital alive than was the case before the advent of the Intensive Care Ambulance system. ⋯ Death from the liver injury itself is usually associated with high grade damage to the liver and the associated hepatic veins and vena cava. It is speculated that improvement in the management of these lethal injuries will come about only from the early identification of patients likely to have suffered such trauma, and the pre-operative control of bleeding. Balloon catheter placement under radiological control, to tamponade the inferior vena cava and abdominal aorta, is suggested as one means by which this goal might be achieved.
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A pilot study of the Trauma Score (TS) was performed from July to September 1983. The Vital Signs Score (VSS) used by the ambulance paramedics, was compared with TS. Of 266 patients suitable for study, TS data was collected for 110. ⋯ If the TS and the VSS were used to select high risk patients for a particular rescue or resuscitation protocol, and scores were selected which gave 100% sensitivity with the highest possible specificity, the positive predictive values of the TS and VSS would be respectively 61.5% and 26.7%. The protocol would be administered unnecessarily to 73.3% of patients selected by the VSS, but only to 38.5% of patients selected by the TS. The TS is proposed as an aid to triage.(ABSTRACT TRUNCATED AT 250 WORDS)