Helvetica chirurgica acta
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Helvetica chirurgica acta · Mar 1993
Case Reports[Unstable spinal injuries in craniocerebral trauma].
Estimates of the incidence of injury to the cervical spine among patients suffering blunt trauma to the head vary widely. In an attempt to quantify the risk, the records of 593 consecutive patients with blunt craniocerebral injuries admitted to our trauma center in 1991 were reviewed. ⋯ In the management of head trauma with associated cervical spine injuries realignment and immobilisation of the spine and surgery of the head were carried out as first step, followed by decompression and stabilisation of the affected segment in the same session. In patients with altered consciousness a loss of cooperation is always present and an early spinal stabilisation for the optimal treatment in the intensive care unit and in the wake-up-phase is important.
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Helvetica chirurgica acta · Mar 1993
[Biliary pancreatitis--a good indication for laparoscopic cholecystectomy].
Recently the indication for laparoscopic cholecystectomy has been enlarged to include biliary pancreatitis. While a majority of reports recommend early open cholecystectomy for biliary pancreatitis the use of laparoscopic cholecystectomy in this disease has not yet been discussed. We retrospectively reviewed 52 patients with biliary pancreatitis being admitted to our ward in the last five years. ⋯ The presence of pseudocysts in our view is no contraindication for laparoscopy. Although it may increase postoperative morbidity. Choledocholithiasis has to be ruled out either by preoperative ERCP or during laparoscopy with intraoperative cholangiography.
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Helvetica chirurgica acta · Mar 1993
[Management of femoral neck fractures at the Liestal canton hospital].
The mode of treatment for femoral neck fractures at the Kantonsspital Liestal depends on age primarily. Patients over 70 years of age are treated with a unipolar endoprosthesis. Screws are being used in cases of medial femoral neck fractures, DHS in cases of lateral fractures. ⋯ Clinically all 13 surviving patients are not compromised by the endoprosthesis after 5 years. We consider the implantation of a unipolar endoprosthesis in patients with femoral neck fractures at age over 70 years the treatment of choice. There is an acceptably low risk for protrusion as a late complication in regard to a reduced life expectancy.
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Out of 224 patients with femoral neck fractures, 40 patients have been treated by ORIF with the dynamic hip screw, whereas 27 have been fixed by large cancellous bone screws and 148 femoral heads were replaced by a prosthesis. The ORIF with dynamic hip screw has been performed as an emergency intervention within 6.2 hours after accident. ⋯ We conclude that these good results are due to the short interval between accident and operation as well as to the evacuation of the intraarticular hematoma together with stable internal fixation and functional rehabilitation. Due to our good results we prefer long cancellous bone screws for the operative fixation of femoral neck fractures in younger patients, whereas in the older group the dynamic hip screw is preferred.
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Helvetica chirurgica acta · Mar 1993
Comparative Study[Polytrauma: comparison of the hospital course after air- (with emergency physician) versus ground transport (without emergency physician)].
We analyzed the influence of initial intensive care at the accident site performed by an emergency physician and followed by helicopter transport on the course during hospital stay in patients with multiple trauma. We therefore compared the dates of 107 patients transported by the swiss air rescue (REGA) and an emergency physician with 131 patients transported by an ambulance and paramedic staff. By similar case material the REGA-patients showed a higher injury severity grade. ⋯ We suspect, that the higher mortality of the REGA-patients is explained by the large number of surgically nontreatable severe traumas. None of the REGA-patients arrived at hospital with circulatory insufficiency whereas 4 of the ambulance-patients were in state of shock. We assume that first of all primary treatment of the scene of injury by an emergency physician and eventually also transport by helicopter have a positive effect on the course of patients with multiple trauma during hospital stay.