Acta chirurgica Scandinavica
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Case Reports
Mediastinal and subcutaneous cervical emphysema caused by perforating sigmoid cancer. Case report.
A case of mediastinal and subcutaneous cervical emphysema due to perforation of a sigmoid cancer is presented. Sudden deterioration and development of subcutaneous and mediastinal emphysema in a chronically ill patient with equivocal abdominal signs should alert the examiner to the possibility of retroperitoneal gastrointestinal perforation.
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Malnutrition is associated with increased incidence of surgical complications and mortality. The efficacy of preoperative parenteral nutrition in preventing septic states and mortality was evaluated in malnourished patients undergoing gastrointestinal surgery. The patients were allocated to three groups according to criteria of malnourishment. In all groups parenteral nutrition decreased the incidence of septic complications and serious sepsis as compared with control patients.
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Nine different brands representing the four main types of modern portable drainage systems (expanding suction balls, suction bellows, spring-loaded systems and high vacuum systems) were examined with respect to the relationship between the degree of filling of the vacuum source and the resulting vacuum. The results are presented first graphically and second numerically with five figures according to a system suggested by the authors. ⋯ These problems are discussed in detail. This article provides baseline data for the different kinds of portable drains currently available and thus gives a background for rational decision making.
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Randomized Controlled Trial Comparative Study Clinical Trial
Linear incision and curettage vs. deroofing and drainage in subcutaneous abscess. A randomized clinical trial.
Linear incision plus curettage under antibiotic cover was compared with conventional deroofing and drainage of subcutaneous abscess in a randomized study of 50 patients. The median healing time was 9 days following linear incision and curettage and 15 days after deroofing and drainage (p less than 0.05). There was no recurrence of abscess during follow-up for 6 months. Linear incision plus curettage under single-dose antibiotic cover thus proved to be a safe method with significantly shorter healing time than after conventional deroofing an drainage.
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Clinical data from 259 patients with suspected acute appendicitis were prospectively collected and used in construction of a Bayesian scoring system, comprising 19 attributes, for preoperative diagnosis. The scoring system was integrated into the routine clinical management of a prospective series of 830 patients. Laparotomy was performed in 310 cases, and of these 256 had acute appendicitis (perforation in 14%). ⋯ The scoring system had 90.2% sensitivity, 91.4% specificity, 82.5% positive predictive value and 95.4% negative predictive value. The system is regarded only as an aid in diagnosis, to be used in combination with clinicians' judgements. Construction of a local data base probably is essential for results equivalent to those here reported.