Annales chirurgiae et gynaecologiae
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Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. ⋯ Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.
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Comparative Study
Clinical distinction of acute and acute on chronic leg ischaemia.
The importance of the distinction between acute embolic ischaemia and acute on chronic ischaemia caused by a thrombus superimposed on an arteriosclerotic stenoses has been emphasized during the recent years, as the differentiation should affect the choice of surgical treatment. A retrospective attempt was made to differentiate between acute ischaemia (AI = embolism) and acute on chronic ischaemia (AOCI = thrombosis) of the leg by categorizing the patients according to the clinical characteristics they presented. The material consisted of 194 ischaemic lower limbs of 189 patients who underwent a balloon-catheter thromboembolectomy because of sudden arterial occlusion. ⋯ The preoperative diagnosis was in better agreement with the retrospective category when AI, as opposed to AOCI, was the aetiology of occlusion (70% vs 46%). The results of the present study emphasize the difficulties of clinical assessment. These findings suggest a routine angiography as an evaluative tool in the planning of optimal management especially as most of the patients today can be treated simultaneously by thrombolysis.
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To evaluate the change in the type of acute leg ischaemia and the outcome of its treatment in relation to the experience of the surgeon responsible for the treatment. ⋯ Mortality and amputation rates in acute ischaemia are high. By judicious use of different treatment modalities, as judged by vascular surgical experience, better limb salvage rates may be achieved especially in patients with acute on chronic ischaemia.
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Clinical Trial Controlled Clinical Trial
The value of osteosynthesis in the treatment of bimalleolar fractures.
A total of 69 patients with displaced bimalleolar fractures were treated by open reduction and internal fixation, 35 using AO/ASIF implants and 34 using biodegradable self-reinforced polyglycolide or polylactide devices. A third group consisted on 35 patients who were treated non-operatively. The result of treatment was evaluated after a minimum follow-up time of twelve months. ⋯ A transient local fluid accumulation was seen in two patients with biodegradable implants. Four patients under non-operative treatment suffered redisplacement of the fracture. In conclusion, biodegradable internal fracture fixation devices proved to be a valuable new method for the treatment of displaced ankle fractures.
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Fifty-two patients underwent laparoscopic Nissen fundoplication. Oesophagogastroscopy, ambulatory 24-hour pH-recording and oesophageal manometry were evaluated both preoperatively and at follow-up. Forty-seven operations were completed laparoscopically, five were converted to laparotomy. ⋯ Dysphagia (28%) and gas bloating (17%) were the most frequent postoperative complaints. A total of 94% of the subjects were satisfied with the result. Our initial experience of laparoscopic Nissen fundoplication shows that the operation is safe and efficient in the treatment of gastro-oesophageal reflux disease.