Annales chirurgiae et gynaecologiae
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Meta Analysis
Concurrent ipsilateral fractures of the hip and shaft of the femur. A systematic review of 722 cases.
Ipsilateral fracture of the hip and femoral shaft is encountered in high-energy trauma, and warrants special diagnostic and therapeutic considerations, which are not available in any single report. Therefore, a meta-analysis was performed. ⋯ Early diagnosis of all injuries and operative treatment of all fracture components are the key factors in reducing complications and improving the outcome in ipsilateral hip and shaft fractures. Locked nails and hip screws yield improved results compared with plates and unlocked nails combined with hip screws. Cephalo-medullary nails have yielded results similar to the first-generation locked nails.
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Randomized Controlled Trial Comparative Study Clinical Trial
Perioperative volume effect of HES 120/0.7 compared with dextran 70 and Ringer acetate.
Hydroxyethyl starch 120 (HES 120/0.7, Plasmafusin) is the smallest medium molecular weight HES preparation used as a plasma substitute for all clinical purposes. We compared the volume and colloid osmotic effect of 6% HES 120 with 6% dextran 70 and Ringer's solution during and after surgery with minimal blood loss. Patients (n = 48) having general anaesthesia were randomly divided into six groups. ⋯ With both infusions rates the COPs of dextran and HES groups were higher compared with Ringer groups. There were no differences in COP between the dextran and HES groups. It is concluded, that in this clinical setting the volume effect of 6% dextran 70 exceeds that of the HES 120/0.7, and that both colloids are superior to Ringer's solution.
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The purpose of this prospective study was to elucidate the characteristics of adult patients with acute abdomen admitted to a Finnish university hospital. A total of 639 patients entered the study. The most common cause of acute abdomen was non-specific abdominal pain (NSAP) (33.0%) followed by acute appendicitis (23.3%) and acute biliary disease (8.8%). ⋯ In conclusion, a considerably large proportion (one third) of cases with acute abdomen remained without any specific explanation. Further, age and gender seem to be important factors when the most probable cause of acute abdomen is to be considered. Operative treatment is necessary in almost half of cases, and mortality for acute abdomen is low.
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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.