Annales chirurgiae et gynaecologiae
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We carried out a four to twelve year follow-up study in thirteen patients aged 63 years and over who were operated on for lumbar disc herniation. In eleven cases the herniation was at the L 4-5 level and in two at the L 5--S 1 level. Additional bony entrapment was present in eight cases. ⋯ Disc removal through a hemilaminectomy or laminectomy with the necessary lateral decompression of the bony entrapment gave a good or excellent result in each of the five patients. It is concluded that disc operation in the elderly usually gives acceptable late results. When even a minor bony stenosis is present at the disc herniation level, hemilaminectomy or even laminectomy should be considered.
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Femoral shaft fractures in the elderly treated with Grosse-Kempf slotted locked intramedullary nail.
Thirty-one femoral shaft fractures in patients over 60 years of age were treated with the Grosse-Kempf slotted, locked intramedullary nail and followed for a median of 24 months. The patients tolerated the operation reasonably well and the mortality was not higher than the mortality connected with femoral neck fractures. Three reoperations were performed due to intra- and postoperative complications. ⋯ A 9 cm shortening among these was the reason for one of the two poor results in the series. The other poor result was a malalignment of the distal fragment in a statically locked fracture. We conclude that locked intramedullary nailing is a good way to treat femoral shaft fractures in the elderly, the high subtrochanteric, midshaft and infraisthmic fractures.
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Comparative Study
A comparison of transthoracic and transhiatal resection for thoracic oesophageal cancer. Observations of 30 years.
The transthoracic and transhiatal resection techniques are compared using the 30-year experience of Oulu University Central Hospital. During the period 1960-1982 we favoured resections trough a transthoracic route, while during the period 1983-1989 a transhiatal route was preferred. This change, and the more enthusiastic attitude adopted towards resection, has lead to an increase in resectability from 23% (46/203) to 62% (43/69) (P less than 0.0001). ⋯ Postoperative pulmonary complications occurred in 28% (13/46) after transthoracic resection and in 14% (6/43) after transhiatal resection. No significant difference was detected in the development of late anastomotic strictures, 33% (15/46) and 30% (13/43), respectively. We conclude that transhiatal resection is as safe as transthoracic resection and seems to allow more resections to be carried out without any increase in mortality or morbidity, but long-term survival remains poor.
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From 1976 through 1985, a total of 1096 children, 0-15 years of age, was treated for fractures in Kuopio University Central Hospital. 131 patients had a femoral shaft fracture and 114 of them, including 82 boys and 32 girls, were studied. The incidence of femoral shaft fracture was 2.16 per 10,000 inhabitants 0-15 years of age. Environmental factors and the ability to move in traffic appeared to be the most important risk factors for femoral shaft fracture.
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Randomized Controlled Trial Clinical Trial
Continuous interscalene brachial plexus block during and after shoulder surgery.
Continuous interscalene brachial plexus block with a single dose of 0.75% bupivacaine (150-210 mg) with adrenaline, continued with an infusion of plain 0.25% bupivacaine 0.25 mg/kg/h, was performed on 20 patients to provide analgesia during shoulder surgery and in the postoperative period. The control group included 20 patients who were given general anaesthesia for surgery after starting a continuous interscalene brachial plexus block; test dose of 0.75% bupivacaine (22.5 mg) with adrenaline, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h. Surgery was performed successfully under regional anaesthesia in 16/20 patients; 4/16 were given one dose of fentanyl during the surgery, and diazepam or midazolam as supplementary sedation were given in 13/16 cases. ⋯ There was a statistically significant difference in the mean plasma bupivacaine concentrations between the groups, concentrations in the regional anaesthesia group being higher at 5, 30, 60 min and 3 h (maximum 2.3 micrograms/ml at 60 min), but there was no difference between the values at 24 h. One infusion of local anaesthetic was discontinued because of probable treatment-related side-effects (breathing difficulties, nausea). Mild local anaesthetic toxicity (dizziness, tinnitus) was noticed in four patients.