ANZ journal of surgery
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ANZ journal of surgery · May 2005
Case ReportsComputed tomography finding of portal venous gas in a patient who survived mesenteric infarction.
Hepatic portal venous gas can be a marker of serious intra-abdominal pathology with mortality between 29% and 79%. We report a case of portal venous gas discovered on computerized tomography in a patient presenting with abdominal pain. The finding was unusual in that the patient was not critically unwell at presentation and made a good recovery after laparotomy with small bowel resection.
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ANZ journal of surgery · May 2005
Case ReportsSmall bowel perforation due to a plastic bread bag clip: the case for clip redesign.
Complications of ingested plastic bread bag clips include small bowel perforation, obstruction, dysphagia, gastrointestinal bleeding and colonic impaction. There have been at least 10 cases of small bowel perforation reported in the published literature. The present paper reports this unusual cause of bowel perforation, which we believe could be prevented by improving the design of this relatively modern device or even by changing the method of sealing bread bags altogether. Interestingly, the date on the offending bread bag clip preceded the presentation of the patient by 2.5 years.
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ANZ journal of surgery · Apr 2005
Severe trauma caused by stabbing and firearms in metropolitan Sydney, New South Wales, Australia.
Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. ⋯ Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.
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Laparoscopic cholecystectomy is a commonly performed procedure in general surgical practice but it also has an inherently steep learning curve. The training of surgeons in this procedure presents a challenge to teaching hospitals, which essentially have to strike a balance between effective training and safety of the patient. The present study aims first to assess the safety of the structured training programme for this procedure at the Department of Surgery, Changi General Hospital, Singapore. Secondly, it seeks to audit the conversion and bile duct injury rates among the laparoscopic cholecystectomies performed by the department, and the factors which influence these. ⋯ A structured training programme involving stepwise progression of training, with close supervision by consultant surgeons and a built-in system of audit can effectively train junior surgeons in laparoscopic cholecystectomy without exposing patients to undue risks.
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The management of patients following severe trauma requires a combination of skills. Among these are accurate clinical assessment, basic resuscitation measures, basic general surgical skills and techniques, good decision making and team leadership. More technically advanced imaging and investigations are often useful and can enhance clinical assessment but should not replace the basic elements. In situations where more advanced investigations are not available good outcomes can be achieved by application of the basic principles in trauma management and surgery. This article describes a mass casualty situation of gunshot wounds managed with limited resources and the outcomes. ⋯ In the present series of gunshot injuries managed with limited resources a good outcome was achieved with the application of basic principles. The present series emphasizes the importance of basic trauma management as outlined in courses such as Emergency Management of Severe Trauma and the use of basic surgical techniques as taught during the Advanced Surgical training program.