ABSTRACT
Management of mangled lower extremity is one of the most challenging problems for a trauma surgeon. The decision of whether to amputate or not and when to amputate is a critical decision. It has surgical, medicolegal, social and psychological importance. Many scoring systems have been devised to facilitate the decision of amputation of an injured extremity. Mangled Extremity Severity Score [MESS] is one of the used scores and it is needed to be evaluated in our country. Of this study was to evaluate the validity of clinical application of MESS for mangled lower limbs and its predictive value in the decision making for injured cases. Fifty patients admitted to the emergency department of the Main Alexandria University Hospital were studied. They were assessed by MESS to have a provisional decision for amputation or conservative treatment. The final decision of conservative treatment or amputation was decided after complete investigations and proper evaluation. In five patients, trials of conservative treatment were done first. The utility of MESS for decision of amputation was assessed. The studied patients were 38 males and 12 females. Their ages ranged between 2.5 and 42 years with a median of 23. 7 +/- 18.]. MESS had a score 7or more than 7for 3lpatients with probability of amputation; and score less than 7 for 19 patients with probability of saving the limb. After complete investigations, trials of revascularization and proper evaluation; amputation was performed for 18 patients. Secondary amputation was done for five of them. The sensitivity of MESS on decision making for amputation was 58% and specificity of the scoring was 63%. Positive predictive value of MESS for amputation was 72% and negative predictive value was 68%. This study showed that MESS has limits for its usefulness and cannot be used as the sole criterion by which amputation decision can be made. With a cooperative multidisciplinary effort with close communication between the trauma, orthopaedic and plastic surgeons, the outcome of mangled lower extremity injuries can be optimized. More limbs could be salvaged by complete evaluation after necessary investigations, continuous surveillance and even operative exploration
Subject(s)
Humans , Male , Female , Injury Severity Score , Amputation, Surgical , Emergencies , Hospitals, UniversityABSTRACT
Acute pancreatitis is a serious disease in surgical practice which may have fatal outcome. The aim of this study was to evaluate the benefits of assessing the severity of acute pancreatitis using various scoring systems and to determine their impact on consequent treatment and prognosis. Nineteen patients were studied in a series. The Ranson's, APACHE II, Multiple organ system failure [MOSF] and abdominal CT scoring systems were used. Seventeen patients [89.4%] had Ranson's score <3, APACHE II score 1-4, CT scoring 0-2 and MOSF score 0. They had clinically mild acute pancreatitis and recovered without mortality. Another 2 patients [10.6%] had Ranson 's score 4 and 6 respectively, APACHE II score 14 and 15, CT scoring 2 in early stage and 3 in late stage; and MOSF score 0 in early stage and 3 in late stage. These two patients developed clinically severe disease with pancreatic necrosis and abscess. Both developed multiorgan failure and died inspite of intensive medical therapy and surgical intervention. Scoring of acute pancreatitis allowed prompt identification of patients with severe disease in need of intensive care unit referral and allowed following up of the course of the disease. Simultaneous scoring by different scoring systems gave better evaluation especially by scores that can be repeated as APACHE II and CT scores. Multiorgan failure was associated with mortality. Endoscopic sphincterotomy was guided by the present pathology rather than the scoring. Infected pancreatic necrosis was an indication for surgical intervention but it still has bad prognosis in spite of early scoring, intensive therapy and surgical intervention