Langenbecks Archiv für Chirurgie
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Even though lungs can be injured solitarily, most of pulmonary lesions occur within the scope of multiple trauma. Because of various patho-physiological processes resulting from the multiple trauma, the valuation of extent, course and prognosis of pulmonary injuries is difficult. Depending on examined cases, mortality of thoracic injuries as stated in various references amounts to between 6 and 55%. ⋯ Because of described variety of injuries, it is necessary for better comparison of clinical investigations to specify the lesions in accordance with general and specific thoracic severity of injury--as described in the multiple trauma score of the Medical University of Hannover--. Especially pulmonary contusions with associated conspicuous injuries are often primarily underestimated concerning their dimensions and consequences. Therefore the importance of subtle inquiry of pulmonary findings must be strictly underlined.
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Langenbecks Arch Chir · Jan 1989
[Recommendation for primary resection with primary anastomosis in complicated sigmoid diverticulitis. Report of experiences of the Herford Surgical Clinic 1973 to 1986].
Of the 107 patients with complicated diverticulitis operated from 1973-1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). ⋯ Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis - 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980 - 1986 the mortality decreased for these operations from 35.7% in 1973 - 1979 to 0% in 1980 - 1986. The indication of primary resection with primary anastomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.