Tropical Surgical abdominal emergencies blunt splenic rupture in Calabar

A detailed study of splenic rupture in 34 consecutive patients living in souttheastern equatorial rainforest Nigeria was conducted during a 5-years period. The results clearly show that blunt abdominal injury from road traffic accident (RTA) was the cause of rupture in the vast majority of cases. Road traffic accident was due in many cases to collision with a motor bike which is a popular means of transportation in this region. Although the external injury to the abdomen was slight; and in some cases nil; the ensuing trauma to the spleen was extensive. In contrast RTA due to the motor car; seen in 5 of the 34 patients studied; caused much associated injury to the patient. The pattern of splenic rupture seen in this tropical African community is out-standingly in contrast with that of the developed countries of the West where spontaneous rupture of diseased spleen seems to be common

Tumores del intestino delgado en la urgencia quirúrgica / Small intestine tumors in surgical emergencies

Se presenta 8 tumores del intestino delgado que se operaron de urgencia en el Servicio de Urgencia del Hospital del Salvador, en 6 ocasiones por obstrucción intestinal y en los otros 2 enfermos por hemorragia digestiva masiva. Hubo 4 lesiones malignas y 4 benignas. Todas se resecaron y el principal problema diagnóstico se presentó en las lesiones que sangraron. Se destaca su frecuencia baja y la tendencia a dar complicaciones graves que obligan generalmente a realizar intervenciones de urgencia

The use of hypnosis as a tool in plastic surgery.

Clinical hypnosis can be valuable tool for the plastic surgeon. Techniques can be rapidly learned at workshops that are held frequently at convenient locations throughout the country. Once misconceptions are dispelled, use of hypnosis is appropriate, safe, and effective.

Operative risk of general surgical procedures in patients with previous myocardial revascularization.

Eighty general surgical procedures with general anesthesia were performed upon 73 patients who had undergone previous myocardial revascularization for significant coronary artery disease. No deaths occurred in this group of patients. Cardiac complications occurred in two patients. A silent myocardial infarction occurred in one patient while another required a permanent cardiac pacemaker for complete heart block. Six noncardiac complications developed in four patients. We concluded that patients with significant coronary artery disease who have undergone previous myocardial revascularization can tolerate subsequent general surgical procedures with limited risk.

Modified Hartmann procedure in emergency sigmoid colectomy.

A new technique has been added to the Hartmann procedure to suture the rectal stump to the presacral fascia using black silk sutures at the time of the initial resection and closure of rectal stump. This will prevent contraction of the rectal stump behind the bladder or vagina deep in the pelvis and makes reanastomosis of the proximal colon to the rectal stump very easy. Also discussed are the advantages of the modified Hartmann procedure in cases of emergency sigmoid colectomy as opposed to the conventional three stage procedure.

Utilization of blood recycling in nonelective surgery.

Intraoperative infusion of autologous shed blood is efficacious in elective vascular, cardiac, and orthopedic surgery. Blood recycling has also been advocated for emergency and trauma surgery. We examined 33 candidates for autotransfusion during emergency surgery. Autologous blood accounted for only 11% of the total blood replaced. Only 25 of the patients survived long enough to permit reinfusion. Because of rapid hemostasis, nine of the remaining patients (36%) received less than the 2 units necessary to be cost-effective. No evidence was found for septicemia or coagulopathy caused by autotransfusion. We concluded that, as currently applied, recycling of shed blood during emergency surgery is of value in a limited group of patients. The collection and storage of heparinized shed blood during the preoperative and early intraoperative periods, with later processing and reinfusion in selected patients, may expand its applicability.

Acute peptic ulcer in childhood. Emergency surgical therapy in 39 cases.

Acute peptic ulcers occurred in 39 infants and children, 22 girls and 17 boys. Eleven patients were less than one year of age. Peptic ulcers were secondary to systemic disease or ulcerogenic medications in 34 cases. Hemorrhage occurred in 27 patients, perforation in 12. Endoscopy was the most useful diagnostic procedure for hemorrhage. Free air was seen on abdominal roentgenogram in all perforated patients. Ligation of the ulcer bed, vagotomy, and pyloroplasty were performed in 25 patients with bleeding. One patient required total gastrectomy. Simple plication was performed in nine patients with perforation. Plication was combined with pyloroplasty and tube duodenostomy in one patient each, and vagotomy and antrectomy were required in one patient. Operative mortality was 5.2%. There were two late deaths (Reye's syndrome and burn sepsis). No ulcer has recurred.

The role of emergency thoracotomy in blunt trauma.

The benefits of emergency room thoracotomy (ET) in the treatment of blunt trauma are controversial. We retrospectively reviewed 38 consecutive cases in whom blunt trauma required thoracotomy as part of the resuscitative maneuver. There were no survivors in this setting regardless of age, sex, and time from injury to arrival. A review of the literature shows questionable salvage rates in such circumstances. Victims of blunt trauma presenting without signs of life are poor emergency thoracotomy candidates, and we suggest that in such patients this procedure be abandoned. Guidelines for emergency room thoracotomy are suggested: that ET should be used in penetrating chest trauma; that it is indicated for noncardiac injuries only if there is pupil reactivity, voluntary respiratory efforts, or purposeful movement, initially or during resuscitation; following ET, if spontaneous cardiac activity cannot be maintained and systemic blood pressure cannot be maintained at least at 70 mm Hg for 30 minutes, patients should be considered unsalvageable.