Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera
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Gunshot wounds to the head have a high morbidity and mortality [1, 2, 3, 4, 5]. In our areas this kind of injury is rarely seen, being mostly due to attempted suicide [6]. To help determine the optimal management of patients with penetrating GSW to the head, retrospective experience with 47 patients from 1986 to 1993 is presented. ⋯ With these informations we decide about the further treatment: We operate patients with stable vital signs, with GCS higher than 3, as long the ventricular system is not involved. 18 patients survived the injury. The currently living 16 patients were examined and checked concerning outcome after GSW to the head. 11 of 16 patients had a GOS 4 or 5. The remaining 5 patients are dependent on permanent help.
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Islet of Langerhans transplantation represents a promising treatment of diabetes. Use of porcine islets for xenotransplantation could offer a solution to shortage of organ donors. However, isolation of pig islets remains a real challenge because of their marked fragility. ⋯ Pig islet allotransplantation, using as recipients surgically pancreatectomized pigs, can be considered as a suitable model to assess the functional results of mass islet isolation. We were able to reverse diabetes transitory in a large animal, by transplantation of purified pig islet preparations. However, even when an immunosuppressive treatment was administered to the recipients, rejection seemed to represent an important factor in the functional outcome of the islet grafts.
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Complications related to wrong or improper perioperative positioning are preventable events. Nevertheless patients may suffer from these complications much more than from the original pathology. In a short review a focus is set on the prone and supine position. Finally remarks for prevention are added.
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Ergot's derivatives are widely used in the treatment of migraine and in the prophylaxy of deep venous thrombosis in association with heparin. Clinical ergotism is rarely observed and can affect all the arteries, especially of the inferior limbs. Vasospasm of the peripheral arteries and collateral formation are specific findings on angiography. ⋯ Under iv sodium nitroprusside and peridural analgesia the spasm resolved in 24 hours. The control Duplex sonography confirm the normality of the lower limb arteries. This examination modality allow a non-invasive diagnosis and evolution control of arteriospasm.
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To define the minimally necessary preoperative evaluation and preparation of an emergency patient of a surgical ward. ⋯ The management of any emergency case is demanding and needs experienced physicians. A schematic procedure adapted to the local possibilities and facilities is helpful for an effective and often life-saving team work between the resuscitation team and surgeons.