Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Nov 1991
Application of the laryngeal mask airway to thyroid surgery and the preservation of the recurrent laryngeal nerve.
We report our experience of using the laryngeal mask airway (LMA) in 13 consecutive patients undergoing thyroid surgery and discuss the advantages and limitations of the technique. We also describe a method, based on the use of the LMA, for identifying and preserving the recurrent laryngeal nerve during thyroid surgery.
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Ann R Coll Surg Engl · Nov 1991
Randomized Controlled Trial Clinical TrialAntibiotic prophylaxis in penetrating injuries of the chest.
Most prospective studies recommend antibiotic prophylaxis whilst a thoracostomy tube is in place or even longer. We conducted a randomised study of 188 patients with penetrating chest injuries requiring a chest drain. Of these patients, 95 received a single dose of ampicillin before insertion of the chest tube, the remaining 93 patients received additional antibiotic prophylaxis for as long as the drain was in place. ⋯ It is concluded that single-dose prophylaxis in penetrating chest trauma is as effective as prolonged prophylaxis. The importance of chest physiotherapy immediately after the drain insertion and of early removal of the drain is stressed. The role of various possible risk factors in the development of sepsis is discussed.
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Ann R Coll Surg Engl · Sep 1991
Assessment of burn injury in the accident and emergency department: a review of 100 referrals to a regional burns unit.
Accurate assessment of the extent of thermal injury in the accident and emergency (A&E) department is essential if appropriate resuscitation and referral to a specialist unit is to occur. However, review of 100 referrals to a regional burns unit confirms that assessment is often inaccurate, and usually undertaken by no one more senior than a casualty officer, leading to suboptimal treatment and referral. Severe thermal injury should be assessed by a team of senior doctors, according to the major trauma protocol, and casualty officers should receive better training in the assessment of less extensive burns.
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The technique of selective arterial embolisation for patients presenting with major hepatic trauma is described. We have used this technique successfully in four patients, three of whom had continued bleeding after emergency laparotomy. It can abolish localised intrahepatic arterial haemorrhage and arteriovenous shunting. Selective embolisation may prove to be a useful technique in reducing the mortality of major hepatic trauma.