ABSTRACT
Thoracic and associated injuries pose problems demanding enormous interdisciplinary efforts regardless of the improved organizational, diagnostic and treatment potentialities. As shown by the experience of the Emergency Surgery Section at the Pirogov Institute, rendering medical services to patients presenting chest and associated injuries require coordinated integration of specialists from various profiles along with specification of the priorities and hierarchy of the emergency measures undertaken. Over a 12-year period (1985 through 1996), a total of 6983 patients with chest, abdominal and multiple trauma are admitted. They are distributed as follows: chest trauma casualties--3286, abdominal trauma--679, and multiply injured--3018. Chest injuries are divided in close and open injuries--2843 and 444, respectively; the latter include 29 gunshot and 415 penetrating-incise wounds. The abdominal trauma group includes 679 cases, distributed as follows: spleen rupture--341, disruption of liver and mesenterium--151, and lesion to a hollow abdominal organ--187.
Subject(s)
Abdominal Injuries/diagnosis , Multiple Trauma/diagnosis , Thoracic Injuries/diagnosis , Triage/organization & administration , Wounds, Nonpenetrating/diagnosis , Wounds, Penetrating/diagnosis , Abdominal Injuries/therapy , Bulgaria , Combined Modality Therapy , Emergency Service, Hospital/organization & administration , Female , Humans , Male , Middle Aged , Multiple Trauma/therapy , Patient Care Team , Thoracic Injuries/therapy , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/therapyABSTRACT
Proceeding from retrospective analysis of 1802 casualties presenting open and closed combined trauma (CT), treated in the Emergency Medicine Institute "Pirogov" over the period 1985 through 1994, attention is focused on the changes in incidence and patterns of associated injuries. Problems relating to organization of the treatment of such patients at the various stages are discussed. The basic requirements of diagnosing and establishing the indications for operation are outlined from the standpoint of general surgery. Finally, the main developmental trends of the therapeutic approach to CT, and the possible ways to find a solution of the most important problems along this line are summed up.
Subject(s)
Abdominal Injuries/epidemiology , Multiple Trauma/epidemiology , Thoracic Injuries/epidemiology , Wounds, Nonpenetrating/epidemiology , Wounds, Penetrating/epidemiology , Abdominal Injuries/diagnosis , Abdominal Injuries/surgery , Adult , Algorithms , Bulgaria/epidemiology , Female , Humans , Male , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/surgery , Retrospective Studies , Thoracic Injuries/diagnosis , Thoracic Injuries/surgery , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/diagnosis , Wounds, Penetrating/surgeryABSTRACT
This is a retrospective study covering 11,142 acute appendicitis patients, operated in the emergency surgery section of the Emergency Medicine Institute "Pirogov" over the period 1986 through 1995. Overall mortality amounts to 0.29 per cent (32 deceased). The dynamic patterns of mortality undergo regression analysis. The basic factors having an impact on thanatogenesis are comprehensively discussed, namely advanced age, premorbidity background, form of appendicitis and postoperative complications. Late diagnosis is the most important factor leading to peritonitis development. Also, peritonitis against the background of concomitant diseases and advanced age proves to be the underlying cause of the fatal outcome of patients--in 24 (75 per cent) of the total number of deaths. The necessary measures contributing to make prompt diagnosis in acute appendicitis, and undertaking more effective treatment of appendicular peritonitis and postoperative complications are outlined.
Subject(s)
Appendicitis/mortality , Acute Disease , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Appendicitis/complications , Appendicitis/surgery , Bulgaria/epidemiology , Cause of Death , Female , Humans , Incidence , Male , Middle Aged , Mortality/trends , Retrospective Studies , Sex DistributionABSTRACT
An attempt is made at specifying the indications for inserting percutaneous transthoracic drain after Seldinger's method. The clinical case material analyzed for the purpose covers 761 patients over a three-year period (1993 through 1995), with 329 of them drained for pneumothorax, 266--hemothorax, and 66--hemopneumothorax. In 54 cases (7.1 percent) switching to surgical draining is necessitated, in 41 (5.39 percent) correction of the drain is done because of inefficiency, and in 96 (12.61 percent)--patency checking and its restoration on the serioscope table. A classification of pathological pleural collections is suggested which proves helpful in estimating whether or not a tube thoracic or percutaneous drain should be employed. The surgeon is cautioned that his assessment should be by no means influenced by the easier procedure under the excuse that it is the method of choice for the patient. Last but not least, one should give due consideration to the financial aspects: percutaneous drainage of the pleural cavity costs about 80 DM, whereas a cigarette thoracic drain costs about 100 leva at the time of analyzing the material.
