Annales chirurgiae et gynaecologiae
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The value of computed tomography (CT) compared with conventional x-ray was assessed in 29 spinal and 9 pelvic fractures. In the so called bursting fractures of spinal vertebrae the position of bone fragments in the neural canal was shown better by CT. The neural canal was remarkably narrowed on several occasions without the patient having any clinical symptoms of root or medullary compression. ⋯ CT was clearly better able to determine whether the fracture extended across the sacro iliac joint. Also in fractures of the iliac wings CT readily showed the internal and external surfaces which were difficult to evaluate on plain radiographic examination. In spinal and pelvic fractures CT can give useful additional information which can influence the treatment of the trauma patient.
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Clinical Trial Controlled Clinical Trial
The prevention of headache following spinal anaesthesia.
The efficacy of various methods in preventing headache following spinal anaesthesia was compared in 797 patients. The postspinal headache occurred in 17.8% of the patients in whom the lumbar puncture was done with a 22-gauge needle. The use of a 26-gauge needle reduced the occurrence of the headache to 7.8% (p less than 0.0125) and the administration of 100 mg of indomethacin six hours after the blockade to 10.3% (p less than 0.05) of the patients. ⋯ In the patients with postspinal headache indomethacin relieved pain as effectively as a stronger analgesic-mixture. Other complaints occurring after the blockade were: pain in the lower back in 9.7% and pain in the lower extremities in 7.2% of the patients. The lithotomy position during the blockade predisposed the patients to these complications.
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Full-thickness abdominal wall defects are mainly traumatic or infectious in origin. After adequate resuscitation, treatment of associated visceral trauma, antibiotic therapy and careful debridement to vital tissues, primary repair of the abdominal wall should be carried out by simple methods by using synthetic mesh and/or split skin grafts. Local pedicle skin flaps or musculocutaneous flaps are advocated for secondary repair of the abdominal wall and also used in elective tumour surgery when total resection of the abdominal wall is indicated.
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The metabolic response to major thermal injury is characterized by gross hypermetabolism with increased basal metabolic rate, increased oxygen consumption, negative nitrogen balance and weight loss. Failure to provide burn patients with sufficient exogenous caloric and nitrogen intake results in catabolic sequelae; impaired wound healing, severe disturbances in regulation of cardiovascular, pulmonary and hepatorenal functions, as well as decreased resistance to infections leading to overt septic episodes. Vigorous nutritional therapy is therefore essential for the survival and optimal care of burn victims. In addition to enteral nutrition -- either by the oral route or with the help of tube feeding, parenteral nutrition is usually required to satisfy the extremely increased energy and protein requirements of the severely burned patient.
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Randomized Controlled Trial Clinical Trial
Epidural anaesthesia with mixtures of bupivacaine-lidocaine and etidocaine-lidocaine.
The mixtures of 0.5% bupivacaine- 1% lidocaine and 1% etidocaine- 1% lidocaine were used in a double-blind manner for lumbar epidural anaesthesia in 48 patients undergoing prostatectomy in order to study whether these mixtures speed up the onset of analgesia, shorten the long motor block, motor block, or improve the quality of analgesia caused by bupivacaine or etidocaine alone. The mixture of bupivacaine-lidocaine caused an analgesia with a somewhat faster onset, similar duration and markedly shorter motor block than bupivacaine alone. ⋯ The analgesia was complete in all 12 patients who received bupivacaine and in 11/12 patients who received the mixture of bupivacaine-lidocaine, but 6/12 patients anaesthetized with etidocaine and 5/12 patients with the mixture of etidocaine-lidocaine experienced considerable visceral pain during the operation. The results suggest that the mixture of bupivacaine-lidocaine produces a block with somewhat better properties than bupivacaine alone, but the mixture of etidocaine-lidocaine does not offer any advantages as compared to etidocaine alone, except the shorter motor block.