Annales chirurgiae et gynaecologiae
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Randomized Controlled Trial Clinical Trial
Intra-articular ropivacaine injection does not alleviate pain after day-case knee arthroscopy performed under spinal anaesthesia.
To evaluate the effect of intra-articular ropivacaine injection on postoperative knee pain after day case arthroscopy. ⋯ This study failed to demonstrate a decrease in postoperative VAS scores at eight hours and later postoperatively when 20 ml of ropivacaine 0.5% were injected intra-articularly after day-case knee arthroscopy performed under spinal anaesthesia. Furthermore, there was no significant difference in the need for postoperative pain medication between the study groups.
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Randomized Controlled Trial Comparative Study Clinical Trial
Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.
The Finnish orthopaedic tradition has preferred hemiarthroplasty to internal fixation in femoral neck fracture treatment, while in Sweden internal fixation has been the method of choice. We decided to study whether internal fixation would prove superior to hemiarthroplasty even in displaced femoral neck fractures in patients over 75 years old. ⋯ We conclude that displaced femoral neck fractures in patients over 75 years should be treated by arthroplasty.
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Comparative Study Clinical Trial Controlled Clinical Trial
Burst abdomen. Local synthesis of nucleic acids, glycosaminoglycans, proteins and collagen in wounds.
Abdominal wound dehiscence and evisceration is a surgical emergency. The general phenomena leading to this complication are for the most part known. However, the local biochemical events of different layers of the abdominal wall in wound dehiscence have not been studied. The purpose of the present study was to analyze the synthesis and contents of DNA, RNA, proteins and collagen in fascial, subcutaneous and skin layers in burst abdomen. ⋯ The results indicate that the degradation of collagen exceeds the synthesis of collagen in wounds of patients with burst abdomen. Probably this increased degradation of collagen in wounds partly explains the higher wound disruption rate in these patients.
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Gunshot wounds of the chest and abdomen are potentially life-threatening, but there is a great variation in their actual severity emphasising the importance of accurate severity assessment for prehospital decision-making, clinical management and outcome prediction. The purpose was to analyse the severity of truncal gunshot injuries from a nation wide data base during a 5-year period with comparison to a previous 5-year period, and to assess the ability of the New Injury Severity Score (NISS) in comparison with the "old" Injury Severity Score (ISS) in predicting short-term morbidity. ⋯ The admission rate for gunshot wounds in Finland is increasing. A large proportion of patients can be managed nonoperatively and the overall outcome is very good. Both ISS and NISS scores can be used to predict hospital morbidity and length of stay with little benefit in replacing ISS with NISS. The assessment of cavitary penetration is useful and has a high negative predictive value for short-term morbidity.
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Medicine has gone through major changes over the last 50 years. Today it is recognized that medical knowledge doubles every 6-8 years. It is also true that with the advent of many new medical procedures, surgeons must continue to learn new techniques throughout their careers; this was not the case in the past. ⋯ Both computerized mannequins and virtual reality training devices are used to teach surgical principles and technical procedures. The natural progression of this technology will be for virtual reality simulations to be used for selecting, training, certifying, and recertifying surgeons. Ultimately, surgeons will practice operative procedures using 3D data sets of the patients they plan to operate the next day and then use recordings to play back their optimal procedure robotically on their patients.