The Surgical clinics of North America
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Hemobilia is a relatively rare manifestation of hepatobiliary disease that is usually characterized by recurrent colicky upper abdominal pain, gastrointestinal bleeding, and obstructive jaundice. In most instances, hemobilia presents as complication of liver injury, blunt abdominal trauma, or liver surgery. ⋯ Treatment of hemobilia is primarily surgical, with direct exploration of the liver, ligation of the bleeding point, and relief of bile duct obstruction. If liver damage is minimal, nonoperative management may be successful but requires careful observation and serial arteriography.
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A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. ⋯ The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.