Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera
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The aim of this study is prospectively to evaluate the serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels in detection of acute appendicitis in patients with right iliac fossa pain. Data were collected in prospective manner on 102 consecutive patients with right iliac fossa pain. Laparotomy was performed for suspected acute appendicitis for 55 of the 102 patients, of whom 49 patients had appendicitis, 6 patients non-appendicitis (NA), and the other 47 patients had nonspecific abdominal pain (NSAP) and they did not undergo operation. ⋯ Although the mean IL-6 levels were significantly different only in PA group than the others groups (P < 0.05). The sensitivity and specificity of serum CRP measurements were calculated as 96% and 87%, respectively whereas these were 33% and 83% for IL-6 levels for the diagnosis of the acute appendicitis. As a result, measurement of the CRP levels and WBC have an additional diagnostic value on the diagnosis of the acute appendicitis but determination of IL-6 levels which added to the test combination of WBC and CRP, the sensitivity for the diagnosis of the acute appendicitis was not changed whereas the specificity was decreased to 66%.
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From 1980 to 1995 inclusive we conducted a study on pelvic ring and acetabular fractures in Kantonspital Chur (KSC). 118 patients were studied and of these 51 had pelvic ring fractures and 67 acetabular fractures. Most of the patients with pelvic ring fractures had additional severe injuries and almost two thirds of them were polytraumatised and very shocked. One third of the acetabular patients were polytraumatised and about one fifth shocked. ⋯ By comparison, those with pelvic ring fractures showed less in the way of radiological complications. 17 patients were seen to have a slight tilt, 9 showed initial signs of arthrosis and there was 1 pseudoarthrosis. Of the 5 patients in this group with neurological damage, 3 had difficulty in achieving an erection and 2 had urological problems. One patient who had a pelvic ring fracture had to have a caesarean section for a subsequent pregnancy.
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To test the usefulness of the Pediatric Trauma Score (PTS) in a university hospital setting. ⋯ The PTS should be used in all injured children in order to identify patients at risk. This would allow to begin an appropriate treatment or, if necessary, initiate a transfer to a surgical pediatric center without delay.
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Unstable fractures of the pelvic ring, associated to perineal lacerations are severe injuries occurring during high-energy trauma. High rates of septic complications and mortality have been reported with these injuries. Current treatment guidelines, while dealing with open pelvic fractures or dislocations are discussed, based on a current review of the literature and on our local experience. ⋯ Repeated wound debridements and wide spectrum antibioprophylaxis were associated. Of these 11 patients presenting an open pelvic fracture, only one died of pelvic sepsis at three weeks. 10 patients survived (91%) and went on to bony union, without any local infectious complications. Aggressive multidisciplinary initial surgical management is a rule when dealing with this type of injuries, immediate colostomy and careful wound debridement must be associated to the initial osteosynthesis.
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We retrospectively reviewed our patients between 1988 and 1996 with duodenal injuries to demonstrate the diagnostic and therapeutic management. ⋯ Duodenal injuries are rare and therefore correct diagnosis and treatment is difficult. In case of penetrating trauma or hemodynamic instable patients following blunt trauma the emergent laparotomy is mandatory. CT scan is recommended in cases of hemodynamic stable patients after blunt trauma. Primary repair is the treatment of choice in the majority of duodenal injuries.