Surgical treatment of patients with open tibial fractures

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitis, which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or gunshot wounds. Initial management of patients with multiple trauma injuries focuses on their life-threatening injuries before or during orthopedic surgical intervention for open tibial fractures. Orthopedic surgeons often work in collaboration with general, vascular, and plastic surgeons and perform multiple surgical procedures (eg, fasciotomy procedures for compartment syndromes, irrigation and debridement of wounds, application of external fixation devices, placement of intramedullary nails, possible limb amputations). The type and extent of open tibial fractures and soft tissue injuries determine the best treatment options for patients. Perioperative nurses should help patients focus on treatment choices for their open tibial fractures that ensure optimal surgical outcomes and maintain their quality of life.     

Surgical treatment of trochanteric fractures of the femur]

The authors present the results of studies of etiology of acute group intestinal diseases in neonates from whom escherichia of serological group 0128ac:K67 possessing the following characteristics were isolated: of the same (with the H12 antigen) serological and enzymatic type (nonfermenting sucrose and raffinose, fermenting dulcit and sorbit the first 24 hours, and slowly fermenting ramnose). All the cultures isolated were resistant to the majority of antibiotics used at present, and were only weakly sensitive to erythromycin. Difficulties (agglutination of live cultures with production sera in the absence of low agglutinability of heated cultures) in serological typing of the cultures were due to different partial O-antigen composition of the cultures isolated and of the production strain used in the preparation of commercial sera of the given serological group (0128ab:K67). Because circulation of escherichia of serological 0128ac variant was revealed in the USSR there occurred a necessity of their identification in practical laboratories; for this purpose organization of industrial production of the corresponding serum is necessary.     

"High risk" anterior basal skull fractures. Surgical treatment of 64 consecutive cases

Information on the number and causes of death is one of the basic components of a country's health information system. Data are usually derived from death certificates and health facility discharge summaries. There are usually several causes of error in the routine collection of this information. A criteria audit of death certificates is presented to assess these sources of error in Papua New Guinea. This procedure involved the systematic and critical analysis of hospital mortality as reported in death certificates. The audit is simple, cheap and useful for monitoring the quality of the mortality information which will be used in health planning and management. Quality criteria are defined and the completeness and relevance of the data audited are discussed. Recommendations for the improvement of the health information system are made.     

Surgical treatment of freshly closed articular fractures of proximal interphalangeal joints

Eleven fractures of the base of P2 and 8 fractures of the head of P1 were treated surgically. We review the results after a mean follow-up of 4 years 5 months. Due to their complexity is no real consensus on the treatment of P2 and various treatments were used. This series demonstrated two points: first the was no correlation between the degree of patient satisfaction and the section of digital immobilization; second, residual subluxation and/or arthrosic remodeling was frequent but was not incompatible with a good objective and subjective outcome.     

Surgical treatment of bronchogenic carcinoma. Long-term results in 496 surgical patients

BACKGROUND: The operability of lung cancer and the period of survival after resection of the lungs in our country does not yet attain the standard recorded in some advanced countries. The objective of the present work is to analyze factors which influence the survival period after resection therapy of lung cancer. METHODS AND RESULTS: In 1985-90 in our department 496 patients were operated on account of lung cancer. This number comprised 31 patients subjected to explorative thoracototomy and three patients with pulmonary resection on account of a stage IIIb (pTNM) tumour who were excluded from the statistical analysis. The retrospective study proper analyzes the results of 462 patients (403 men and 59 women) operated in stages I, II and IIIa. Their mean age was 57 years (range 30-74 years, SD 7.5 years). The most frequent histological type was epidermoid carcinoma (68.8%), adenocarcinoma 18.2%, small-cell tumours 5.4% (25 patients). In 262 patients operated on account of lung cancer in stage I (pTNM) the probability of five-year survival was 49.2%, in patients in stage II 42.1%, in 158 patients in stage IIIa 20.9% (for all histological types combined). In 437 patients after resection of the lungs on account of non-small-cellular carcinoma the probability of five-year survival was as follows: stage I 50.0%, stage II 45.0%, stage IIIa 21.2%. CONCLUSIONS: The probability of five-year survival for the whole group of 462 patients in stages I, II and IIIa was 38.8%. The most important factor which influenced the probability of five-year survival was the stage of the disease. Neither age nor sex of the patients nor the histological type of the tumour had a statistically significant effect on the probability of five-year survival.     

Surgical treatment outcome of hemorrhoidal in 475 patients

OBJECTIVE: The process of aneurysm formation after laser welding is described. SUMMARY BACKGROUND DATA: The mechanism of aneurysm formation after laser-assisted microarterial anastomosis is presently unclear. METHODS: A series of 830-nm diode-laser-assisted longitudinal aortorrhophy with a condition of 400 to 500 J/mm2 for 1 cm length of anastomosis versus conventional manual anastomoses were performed in 90 Wistar rats. To compare this technique with normal media process, a histologic examination of aneurysm formation was conducted. RESULTS AND CONCLUSIONS: The results show that there are two important factors that cause aneurysm formation after laser-assisted anastomosis: 1) the vessel wall is damaged by laser heating; 2) proliferation of collagen fiber at the adventitia is absent during media reconstruction.     

Surgical treatment of intracranial meningiomas in geriatric patients

We studied retrospectively a series of 36 patients who underwent the surgical removal of an intracranial meningioma between April, 1982 and April, 1997. Their ages ranged from 65 to 78 years (mean age: 70.2 years); 27 patients were female, and 9 were male. Thirteen (36.1%) were located at the convexity, 6(16.7%) at the falx/parasagittal area, and 16(44.4%) at the skull base, tentorium, and posterior fossa. Operative mortality was 11.1%, but the rate was increased to 16.7% at 3 months follow-up. It was significantly higher than the younger age group (p < 0.05). Postoperative complications were manifested in 17 of 36 patients (47.2%). The postoperative morbidity rate was significantly higher in patients with class III of ASA physical status (American Society of Anesthesiology classification). Twenty-three (63.9%) patients had good postoperative outcome (Karnofsky rating scale of 80 or more). Various prognostic factors were evaluated, the most important of which were preoperative general health condition and neurological status. Age per se is not a contraindication to the surgery of intracranial meningiomas in the elderly patient.     

Surgical treatment of thyroid diseases in geriatric patients

Thyroid diseases have a characteristic evolution in geriatric age, whether for the symptomatology frequently mingled with typical manifestations of again, or for glandular involution. Moreover, in the aged patient, the particular aspect of the epidemiology, physiopathology, clinic and therapy are to know and interpret. In most cases, the presence of a uni- or multi-nodular goiter does not cause compression problems or cancerization risk. In the presence of these problems and in multi-nodular goiter, we prefer total thyroidectomy because, at the present time, it is possible to put at zero the risks of this operation, neither we fear hypothyroidism which all the same also appears in less extensive operations. Between thyroid diseases, cancer has a typical biological behaviour and prognosis in geriatric patients. While most tumors have a better curability in geriatric age, these have a worse prognosis. So therapeutic indications very as a function of age. About this the authors present preliminary data of a prospective trial started in 1992.     

Surgical treatment of laryngotracheal stenosis: a review of 60 cases

STUDY OBJECTIVE: To determine the influence of temperature and duration of cardiopulmonary bypass (CPB) on blood loss and transfusion requirements. DESIGN: Retrospective chart review. SETTING: Tertiary care, academic medical institution. MEASUREMENTS AND MAIN RESULTS: The charts of 378 patients who had undergone primary elective coronary artery bypass graft surgery were studied. Systemic perfusion of CPB had been conducted between 20 degrees C and 37 degrees C in all patients. Patient demographic, temperature during CPB, duration of CPB, blood loss, and transfusion requirements were all recorded. Hypothermic CPB patients had minor increases in requirements for transfusion of red blood cells (RBC; p = 0.01), fresh frozen plasma (FFP; p = 0.01), platelets (PLT; p = 0.003), and total (allogeneic and autologous) blood products (p < 0.001). Multivariate analysis revealed that decreased temperature after adjusting for duration was predictive of allogeneic (RBC, FFP, PLT, and cryoprecipitate) and total (allogeneic and autologous) transfusion requirements. The duration of CPB correlated with decreased temperature (r = -0.455; p < 0.0001). After adjusting for temperature, duration was only predictive of total (allogeneic and autologous) transfusion requirements. CONCLUSIONS: The institution of warm CPB has many ramifications for clinical practice. The hypothermic induced platelet dysfunction and increased duration associated with cold CPB may contribute to the minor increases in transfusion requirements. However, temperature appears to be a weak factor, neither supporting nor refuting the use of warm or cold CPB.     

Behavioral treatment of children's fears: A review.

Reviews behavioral literature on childhood fears, including conceptual models, normative research, and fear-reduction studies. The main conclusions are as follows: (a) The information value of nearly 60 yrs of normative studies is meager, and their continuation is of doubtful value. (b) Most research has been limited to laboratory studies of mildly to moderately fearful children, and few data exist on severe fears studied in the child's natural environment or on the clinical prevalence of fear. (c) Cognitive and developmental factors have been largely ignored. (d) Modeling is the most frequently used and reliably effective fear-reduction strategy. (e) A cognitive, verbal-mediation approach is promising but is not yet sufficiently researched. (f) There is little evidence that systematic desensitization or contingency management strategies are effective. Implications for large-scale fear reduction and prevention are discussed. The need for research that recognizes the complex paradigms of children's fears is suggested. (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)