Helvetica chirurgica acta
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Helvetica chirurgica acta · Sep 1993
[Computerized tomography follow-up in the acute phase after craniocerebral trauma].
Because of methodological reasons, within the first day after a head trauma, CT scan often does not demonstrate all the pathological consequences of brain injury. Additionally, secondary sequelae are frequent events. In our series of 129 patients the findings on subsequent CT scans done during the posttraumatic course were worse compared to the initial CT in 45% of patients. ⋯ In the vast majority of cases, this happened within the first 2 weeks after the initial trauma. We conclude that an initially pathological CT should be repeated early in the posttraumatic period even in patients with mild to moderate head injury. In particular, we recommend that patients having sustained diffuse brain injuries should be transferred to neurotraumatology units for specialised management, even when there may not be immediately obvious indications for surgical intervention.
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Helvetica chirurgica acta · Sep 1993
[Quality of emergency admission (resuscitation, REA) and first aid in multiple trauma].
Undue delay between hospital admission and the beginning or urgent operative procedures is considered as a major mortality risk for polytraumatized patients in any trauma center. As part of a quality control study at our institution (Kantonsspital, University of Basel), the time spent for early resuscitation and diagnostic procedures was therefore prospectively recorded in 20 patients (mean age 38 years) with a mean ISS of 26.9 (range: 13 to 43). Time spent in the resuscitation room averaged 31.4 min (range: 10 to 50 min). ⋯ Diagnoses established during this period were both accurate and comprehensive, as detectable from the low rate of missed diagnosis (three minor fractures). Although our results match favorably with figures reported in the literature we feel that further improvements could be achieved by performing the conventional radiographic procedures simultaneously with the early resuscitation in the resuscitation room. At present time, for reasons of X-ray protection, this is not possible in our institution.
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Helvetica chirurgica acta · Jun 1993
Case Reports[Hemorrhage from pseudocysts caused by pseudoaneurysms in chronic pancreatitis. Diagnosis and management].
Bleeding pseudocysts respectively pseudoaneurysms represents a seldom complication of chronic pancreatitis in owing to erosion of pancreatic or peripancreatic arteries. The potential rupture into neighbouring organs or in the peritoneal cavity is accompanied with paramount life-threatening risks. During the last years we observed 3 patients with acute intestinal bleeding caused by pseudocysts converted to pseudoaneurysms. ⋯ With management of these patients with hemorrhagic complications of pancreatic pseudocysts we acquired the following findings: 1. Patients with known chronic pancreatitis and abdominal tumor, especially when accompanied by epigastric pain and anemia, are highly suspicious for pancreatic pseudoaneurysms. 2. The color-doppler ultrasound is the best diagnostic tool, since this investigation can establish the pseudoaneurysm and identify the source.
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Helvetica chirurgica acta · Jun 1993
[The significance of computerized tomography for conservative treatment of liver trauma].
Increasing experience with early radiological evaluation by ultrasound (US) and computed tomography (CT) of patients with abdominal trauma is leading to more frequent use of conservative treatment in patients with severe liver injuries. In a retrospective study with predominant use of peritoneal lavage only 3 out of 100 patients with liver injuries were treated non-surgically. In a consecutive prospectively evaluated series of 75 patients with early use of US and CT, 30 patients in stable circulatory conditions were treated non-surgically. ⋯ Although a precise anatomical classification of the liver injury degree seems difficult, the predictive value of computed tomography for non-surgical treatment was good. Use of iv-contrast is mandatory. We conclude that in experienced hands computed tomography allows precise evaluation of liver injuries for adequate treatment, provided careful follow-up (intensive care unit, CT, angiography) ensues to avoid complications.
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Helvetica chirurgica acta · Jun 1993
[Combined fractures of the femoral neck with femoral shaft fractures].
Ipsilateral fractures of the femoral neck and shaft presents diagnostic difficulties and complex choices as to treatment. The surgeon is often faced with a multiply-injured patient with an obvious fracture of the femoral shaft. The accompanying femoral neck fracture can be overlooked (20-50%). ⋯ ISS < 25: Interlocking nailing for the shaft fracture and supplementary screws for the neck fracture, 2. ISS > 25: Plating for the shaft fracture and screwing for the neck fracture. The aseptic necrosis of the femoral head is not frequent.