Journal of the Royal College of Surgeons of Edinburgh
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J R Coll Surg Edinb · Jun 1993
Review Case ReportsAir-weapon crimes and accidents: a source of preventable injury.
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Conservative management of splenic injuries following blunt abdominal trauma is receiving increasing support following delineation of the role of the spleen in preventing infections. This report describes experience with the treatment of 215 consecutive cases treated between 1982 and 1989. A total of 38 patients underwent non-operative management (NOM), 16 splenorrhaphy, 16 partial splenectomy, 60 splenectomy with autotransplantation and 85 splenectomy alone. ⋯ No major complications were observed in the autotransplantation group; a good function and morphology of the re-implanted splenic tissue was always evident by radioisotopic, echographic and histological studies. A conservative approach should always be considered in splenic trauma. In cases where NOM, splenorrhaphy and partial resection are unsafe, splenectomy with autotransplantation should be considered as this simple and reliable technique allows preservation of splenic function.
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J R Coll Surg Edinb · Jun 1993
Comment Letter Comparative StudyPassive tube and suction drainage after elective cholecystectomy--a comparison using ultrasonography.
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The severity of postoperative pain after thoracotomy means that total analgesia cannot be achieved with a single method or agent without significant side-effects. Recent advances in our understanding of the mechanism of pain generation and maintenance mean that measures prior to surgery greatly affect the requirement for postoperative analgesia. We review the methods available for post-thoracotomy analgesia in the light of our knowledge of peripheral and central mechanisms of neuronal hypersensitivity. The combination of opiate premedication, preoperative non-steroidal anti-inflammatory drugs (NSAIDs), preincisional regional block and postoperative continuous paravertebral block together with NSAIDs may be the ideal combination for near total analgesia following thoracotomy.
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J R Coll Surg Edinb · Apr 1993
Review Clinical TrialCombined predeposit and salvage autotransfusion in elective aortic aneurysm repair.
In this study assessing the safety and value of the routine use of autotransfusion in elective aortic aneurysm surgery, the first 16 patients (control group) received homologous transfusion only, while the subsequent 38 patients (autotransfusion group) received a combination of predeposit and salvage autotransfusion (Solcotrans device). Between 1 and 3 units of blood were venesected preoperatively, and a median of 0.80 (0.20-2.75) litres of unwashed shed blood was salvaged and re-infused (48% of the measured blood loss). ⋯ There were no haematological or biochemical complications. Predeposit and salvage autotransfusion is simple and safe, and reduces banked blood requirement in aortic aneurysm surgery.