Injury
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Comparative Study
A conservative approach to penetrating injuries of the chest. Experience with 131 successive cases.
One hundred and thirty-one cases of penetrating injuries of the chest were reviewed prospectively. A policy of conservative management is advocated, based on the intercostal drainage of moderate or large collections of fluid and/or air. The site of the intercostal drain is not an important factor in the management.
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Five patients with blast injuries to the lungs after bomb explosions are reported. In each patient radiological changes were apparent on the initial chest film taken within 4 hours of the explosions. Arterial hypoxaemia was also present. ⋯ Two patients died, one owing to bilateral pneumothorax which occurred during anaesthesia, and the other owing to overwhelming infection. Hypoxaemia persisted for 4 months in one of the survivors. Lung function tests which were performed on the same patient 10 monhts after the blast injuries, however, were normal.
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The control of massive haemorrhage in major hepatic injury with caval damage is extremely difficult. Our experience with 5 such patients is reported. ⋯ In 3 patients control was obtained and repair effected without recourse to internal caval shunting. One of these patients survived in spite of extensive injuries.
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The personal experience of a general practitioner who sustained a fracture-dislocation of the atlanto-axial joint is recorded. The inefficient application of an unyielding (non-inertial) lap and diagonal seat belt permitted this injury, although one does not know what other injuries might have occurred had the belt not been worn.
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Twenty-nine patients with non-union of the humeral shaft, who were treated in 3 major Vancouver hospitals, were studied. Reasons for non-union, effectiveness of various treatment methods, and complications are discussed. ⋯ Compression plating with cancellous bone grafting gave the best rate of healing. However, both early and late operative treatment gave a relatively high complication rate.