Diagnosis and management of small bowel and mesentery injury following blunt abdominal trauma in 12 cases

Over four years [April 2004 to December 2008] 12 patients with blunt small bowel and mesenteric injuries were treated at three hospitals dealing with trauma. Ten cases were victims of traffic accidents, of whom 70% wore seat belts. There were 11 small bowel injuries [4 full-thickness and 7 seromuscular] and 9 mesenteric injuries [3 with and 6 without a de-vascularized bowel segment]. All were managed initially following the Advanced Trauma Life Support [ATLS] guidelines. Emergency room ultrasound was positive for blood in 5/7 cases [71%] and CT scan in 2/4 [50%]. Diagnostic peritoneal lavage [DPL] was performed in one case and was positive for blood

Randomized clinical study of recurrent laryngeal nerve status post thyroidectomy

The objective of this clinical study was to show the risk of recurrent laryngeal nerve injury after thyroidectomy which could be unrecognized without routine laryngoscopy. This is a retrospective randomized study which evaluates vocal cord function before and after thyroidectomy by laryngoscope. Persistent cord palsy for longer than 12 months after the operation was regarded as permanent. From March 2002 through March 2005, At Ain Shams University hospitals, 200 operations upon the Thyroid gland were done [26 males and 174 females] with documented normal cord function at the side of the thyroidectomy. There were 74 unilateral and 126 bilateral procedures, with 326 nerves at risk of injury. Postoperative unilateral cord palsy was documented in 15 patients [7.5%] during routine postoperative vocal cord examination. Twelve patients [6%] developed transient unexpected postoperative unilateral cord paralysis, and three patient had permanent cord paralysis one of them had recognizable nerve damage during the operations for malignant goiter, the other 2 patients one was malignant goiter and the other was recurrent goiter with extensive adhesion. During a median period of 5 months [range, 1-9 months], 12 [80%] of these 15 patients had recovery of vocal cord function with preceding improvement in phonation. The incidence of transient and permanent recurrent nerve palsy was 6% and 1.5% [3.7% and 0.9% of nerves at risk], respectively. There was increase risk of recurrent laryngeal nerve injury after thyroidectomy which could be unrecognized without routine laryngoscopy, and patients have a good potential for recovery. Thyroid surgery for malignant neoplasm and recurrent goiter was associated with an increased risk of permanent recurrent nerve damage