[Thoracic stab wounds]. / Heridas torácicas por arma blanca.

Stab wounds are the most common cause of open chest wounds in our setting, with an incidence far higher than either wounds caused by firearms or bull horns. We describe a series of 49 patients, 44 (89.8%) men and 5 (10.2%) women. Mean age was 31 years. The 49 patients had suffered 72 stab wounds to the chest, of which 30 (41.6%) were penetrating and 42 (58.3%) were non penetrating. The lesions observed were 11 (22.4%) cases of pneumothorax, 10 (20.4%) of hemopneumothorax, 6 pulmonary lesions, 2 heart wounds and 1 extensively damaged diaphragm. Twenty-four patients with non penetrating wounds and 8 with penetrating wounds were treated conservatively. It was subsequently necessary to drain the chest of only one. Of the remaining penetrating wounds, drains were inserted in six immediately and 11 underwent surgery. Complications developed in only 9 cases. One patient died as a result of abdominal lesions resulting from stab wounds directly to the abdomen. We are in favor of conservative management. Indications for more aggressive intervention are hypovolemic shock, cardiac tamponade or significant loss of fluid through the thoracic drain.

Postoperative analgesia with i.v. propacetamol and ketoprofen combination after disc surgery.

PURPOSE: The concept of balanced analgesia suggests that a combination of analgesic drugs may enhance analgesia and reduce side effects after surgery. This study evaluated the effect of the combination of propacetamol (Prodafalgan) and ketoprofen (Profenid) after surgery of a herniated disc of the lumbar spine. METHODS: After randomization, 60 patients received: placebo (group 1); 2 g propacetamol (group 2); 50 mg ketoproten (group 3); or a combination of 2 g propacetamol and 50 mg ketoprofen (group 4). Drugs were administered every six hours for two days after surgery. The patients used morphine with patient controlled analgesia pumps (bolus 1 mg; lock out time 10 min) and were evaluated with a visual analogue scale (VAS) at rest and movement every six hours for two days. Side effects were noted. RESULTS: The patient characteristics and surgery were identical for each of the four groups. The VAS scores throughout the study were lower in group 4 than in groups 1, 2 and 3 both at rest (P < 0.05) and on movement (P < 0.01). The cumulative dose of morphine at 48 hr was lower in group 4 than in group 1 (23.4 +/- 5 mg vs. 58.9 +/- 9 mg; P < 0.01) or group 2 (23.4 +/- 5 mg vs 43.4 +/- 6.6 mg; P < 0.05) and similar to that in group 3 (34.2 +/- 4.5 mg). The incidence of side effects was similar in all groups. CONCLUSION: The combination of propacetamol and ketoprofen reduced pain scores both at rest and on movement. The drug combination did not reduce the morphine consumption and incidence of side effects.

Local anesthesia by jet-injection device in minor dermatologic surgery.

BACKGROUND: Pain and needle-phobia can be a problem during the application of local anesthesia with syringe and needle. OBJECTIVE: To evaluate a jet-injection device (without needle) to deliver local anesthesia. METHODS: Two hundred and six minor dermatological procedures using a jet-injection device for administering local anesthesia into skin tissue were performed. We comment on the technical procedures, application, usefulness in relation to areas involved and the anatomical location of lesion, and total dosage of the anesthetic agent. RESULTS: Total absence of pain during installation of anesthetic (N = 194; 94%). Good level of anesthesia in all patients. No local adverse effects. CONCLUSION: The jet-injection device is easy to handle, it is harmless, it provides good levels of anesthesia, and the dosage of anesthetic agent is smaller than the dosage administered with conventional methods.