Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera
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There is nowadays no current randomised study able to answer if a diverting colostomy is necessary or not in the surgical management of civilian colon trauma. We report our experience on 13 cases treated during the period from 1977 to 1997. There were 3 stab wounds, 4 gunshot traumas and 6 perforations of the colon caused by blunt mechanisms. ⋯ This often is the case with stab wounds and low velocity gunshot traumas. We would prefer a diverting colostomy in cases of blunt trauma of high energy and while haemodynamic instability makes the estimation of adequate tissue vascularisation difficult. Colonic lesions due to high velocity bullets should be managed as if they where wounds of war.
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Techniques of operative treatment of supra- and intercondylar fractures have changed in recent years. These changes refer to reduction techniques and implant selection. Operative approach concepts, which remained unchanged for several decades were critically evaluated and modified to a minimal invasive osteosynthesis [MIO]. ⋯ They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. The patients in this group with severe injuries need a detailed treatment algorithm, because the surgeon's individual skill, enthusiasm and wishful thinking frequently led to unsatisfactory results. A decision making scheme is presented specifically addressing timing and treatment modalities.
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Case Reports
Direct repair of right atrial rupture after blunt chest trauma without cardiopulmonary bypass.
Tamponade from free wall rupture of the cardiac chambers following blunt thoracic trauma is relatively frequent. Diagnosis requires a high index of suspicion and is rapidly confirmed by echocardiography. Emergent surgery is always mandatory despite apparent stable vital signs. We report a successful repair of a lacerated right atrium without cardiopulmonary bypass (CPB), saved in extremis after undue in-hospital delay.
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Case Reports
[Closed injuries of the intrahepatic bile ducts--clinical presentation, diagnosis and treatment].
Two cases of blunt trauma of the intrahepatic bile ducts are described: one illustrates the difficulty to establish a diagnosis that is often delayed, the other emphasizes the usefulness of the peroperative cholangiography to precise the diagnosis and define the treatment. In the two cases a simple drainage either perihepatic or of the common bile duct resulted in complete healing of the biliary wound. When liver rupture and bleeding complicates a biliary injury, efficient packing allows to reoperate the patient under better conditions the next day. According to the extent and location of the biliary injury, simple drainage, direct suture, bilio-digestive anastomosis and even hepatectomy in rare cases will be indicated.
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Several studies reported in the literature show that surgical procedures can be carried out for other than clinical indications. In Switzerland, no statistics on the "demography" of surgical procedures are available. But an earlier analysis of the "Swiss Health Survey 1992/93" gave first indications on differences in rates of surgical procedures (hysterectomy, appendectomy, tonsillectomy and operation of the hip and gallbladder) by sex, educational status and region. ⋯ These findings should stimulate patients to ask for a "second opinion". Furthermore, there is an urge for the implementation of general hospital statistics to verify such findings. In addition, the scientific consensus on the indication of several surgical procedures should be promoted on the way to more evidence-based-medicine.