Annales chirurgiae et gynaecologiae
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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.
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Barrett's esophagus is a premalignant metaplastic change in the lining of the distal esophagus. It represents a peculiar form of healing which can occur at any time in patients with reflux esophagitis. Ninety percent of patients with Barrett's esophagus have a mechanically defective lower esophageal sphincter and 93% have abnormal esophageal acid exposure on 24 hour esophageal pH monitoring. ⋯ Despite extensive endoscopic sampling of the esophageal mucosa the differentiation between high grade dysplasia and invasive adenocarcinoma is unreliable. Esophagectomy remains the treatment of choice for patients with high grade dysplasia. Barrett's adenocarcinoma can be cured by en bloc esophagectomy in selected patients with early disease.