Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The traumatic pulmonary hernia is a rare and uncommon observation. We report a case of a 52-year-old patient who had a car accident. ⋯ We relocated the hernia into the chest and stabilized the thoracic wall. The postoperative course was uneventful.
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Review Case Reports
[Fixed rotatory subluxation of the atlanto-axial joint in polytrauma patients].
Traumatic atlanto-axial instabilities are rare entities in cervical spine injuries. There may be only subtle abnormal findings by plain radiographs, frequently resulting in a missed or delayed diagnosis. We report a polytraumatized patient with severe maxillofacial injuries, where preliminary radiological studies failed to verify rotatory instability of the atlanto-axial joint. A definite diagnosis was only established by further imaging studies, including CT scan reformations.
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The diffuse angiomatosis of the spleen is a rare splenic proliferation. Spontaneous rupture is the main, potentially lethal complication, found in 25% of cases. The problem with these vascular tumors is preoperative diagnosis, because they are asymptomatic for a long time. ⋯ In the case of rupture, splenectomy is a life-saving procedure. We report on a 56-year-old woman with a spontaneous splenic rupture as the first symptom of diffuse angiomatosis of the spleen. Exceptional features of splenic hemangiomas, causes of spontaneous rupture and the therapy are described.
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A diagnostic scoring system, recently published by Ohmann et al. in this journal, was validated by analyzing the clinicopathological data of a consecutive series of 2,359 patients, admitted for suspicion of acute appendicitis. The results of the scoring system were compared to the results of clinical evaluation by junior (provisional) and senior surgeons (final clinical diagnosis). To assess the diagnostic ability of the score, the accuracy and positive predictive value were defined as the major diagnostic performance parameters; the rate of theoretical negative laparotomies and that of diagnostic errors served as the major procedural performance parameters. ⋯ With regard to the main procedural performance parameter, the score resulted in a significantly smaller number of diagnostic errors than the provisional clinical investigator (P < 0.05, chi 2 test). The results of this study indicate that the diagnostic scoring system might be helpful when experienced investigators or additional diagnostic modalities such as ultrasonography are not available. It may therefore be of value in the preclinical evaluation of patients with suspected acute appendicitis and may be instrumental as a quality control tool and in clinical guidelines.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Pain therapy after thoracoscopic interventions. Do regional analgesia techniques (intercostal block or interpleural analgesia) have advantages over intravenous patient-controlled opioid analgesia (PCA)?].
Systemic opioids and thoracic epidural analgesia are common techniques used to provide post-operative analgesia following thoracoscopy (video-assisted thoracic surgery). The aim of the present prospective randomised study was to evaluate the efficacy of two less invasive analgesic techniques, intercostal blocks (ICB) and interpleural analgesia (IPA). After approval from the ethics committee and informed consent from the patients, 36 patients scheduled for thoracoscopic surgery were randomly assigned to a group for postoperative pain management: group ICB: intercostal blocks of the segments involved with 5 ml 0.5% bupivacaine at the end of surgery and 6 h later; group IPA: interpleural analgesia with 20 ml 0.25% bupivacaine applied every 4 h using a catheter placed during surgery near the apex of the interpleural space; control group: IV-opiod-PCA with piritamide. ⋯ Nevertheless, effective pain management is necessary. We could not demonstrate a significant reduction in piritramide consumption for the techniques of regional analgesia tested here (ICB, IPA). We conclude that the use of these techniques is not complementary after thoracoscopy, since an opioid (PCA with piritramide) combined with a non-opioid (metamizol) resulted in satisfactory analgesia.