Wiadomości lekarskie (Warsaw, Poland : 1960)
-
Comparative Study Clinical Trial Controlled Clinical Trial
Operative management of the flail chest.
The management of flail chest (FC) has been the subject of controversy for many years. The aim of our study was to compare results of the management of patients with FC after operative stabilization (OS) vs. nonoperative treatment (NT). One hundred and thirty-three consecutive patients with FC were assigned to treatment with OS (40 patients) and NT (93 patients). ⋯ No difference in age, sex, shock ISS, severity pulmonary and heart contusion, extensive FC were found between both groups. Results of treatment are the following (for OS and NT respectively, p < 0.05): pneumonia 15% (6) vs. 34.4% (32); PaO2/FiO2 - 333.4 +/- 12.3 vs. 286.5 +/- 14.7; duration of lung ventilation (days) - 2.3 +/- 0.6 vs. 6.3 +/- 1.2; mortality rate - 22.5% (9) vs. 46.2% (43). Operative stabilization of chest wall should be considered when extensive FC occurs, particularly for patients with severe pulmonary and heart contusion.
-
The appropriate anesthesia for renal transplantation (RT) requires minimal toxicity for patient and transplant besides of sufficient pain relief and correction of vital functions. Since 1990 for this reason prolonged epidural anesthesia (PEA) was used for 42 RT. The catheterization of epidural space was performed on the spine level Th9-Th12. ⋯ Less cardiodepressive effect, stable intraoperative hemodynamics and absence of serious post-operative pulmonary complications were observed in patients operated under PEA. Also less toxic action of PEA for recipient as well as for renal allograft was marked. Obtained results show that PEA might be the preferable method for RT due to its lower toxicity, significantly less number of postoperative complications.
-
A detailed analysis of 234 trauma patients who died after being admitted to the Department of Trauma Surgery in 1990-1996 has been performed in prospective studies. Among all fatalities multiple injuries have been diagnosed in 86 persons (36.7%) while single injuries have been found in 148 persons (63.3%). The mean Injury Severity Score (ISS) was 18. ⋯ Preventable diagnostic errors and deficiencies in management of multiply injured patients have been committed mainly in the early resuscitative phase. A decrease of PDR in fatalities treated lately in our Department has been recorded. Other aspects concerning studies on preventability in trauma patients have been discussed.
-
Measurement of severity of injuries is by all means needed in contemporary traumatology. Objective assessment of several different injuries is helpful in different comparisons concerning different groups of trauma patients. The authors have chosen 4 number scales: Trauma Scale (TS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and APACHE (Acute Physiology and Chronic Health Evaluation) in order to assess their application in traumatological practice. Advantages and disadvantages of number scaling describing of severity of injuries in trauma patients have been discussed.
-
Case Reports
[Vomiting as a symptom of a developing psychological eating disorder in a 15-year old girl].
A case of difficulties in diagnosis of anorexia nervosa in a 15-year-old girl is reported. Before 1960, anorexia nervosa was rarely recognized, and bulimia was not known, as a nosological entity. ⋯ However, they may, lead to heavy losing of weight accompanied by emaciation. Successful treatment depends on appropriate therapy managed by a psychologist, psychiatrist and endocrinologist.