The British journal of surgery
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The clinical presentation and management of 102 vascular injuries associated with bone and joint trauma, in 100 patients over a 6-year period, is reviewed. Eighty-three injuries involved the lower limbs. Amputation became necessary in 16 patients. ⋯ The orthopaedic injury should be treated on its merits. In contaminated or comminuted fractures skeletal traction (or in suitable cases exoskeletal fixation) can be employed without adversely affecting the vascular repair. A plea is made for early diagnosis of concomitant vascular injury in patients with bone and joint injuries; this depends on clinical awareness and careful and repeated examination.
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We have performed coeliac plexus block by standard percutaneous technique for disabling pain in 36 patients (13 with cancer and 23 with chronic pancreatitis). Eleven of the 13 cancer patients had complete pain relief initially and 7 remained pain free at the time of death. By contrast, only 12 of the 23 patients with pancreatitis had complete pain relief, 6 had partial relief and there was no effect in 5. ⋯ Benefit was least in patients with previous pancreatic surgery and repeat blocks were unhelpful. Transient postural hypotension occurred in most patients; two had nerve root pain and one developed persistent weakness and anaesthesia of the left leg, with bladder disturbance. These results warrant the continuing use of coeliac plexus block in pancreatic cancer, but rarely in chronic pancreatitis.
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Randomized Controlled Trial Comparative Study Clinical Trial
A physiological appraisal of polyethylene glycol and a balanced electrolyte solution as bowel preparation.
Seventy-seven patients undergoing bowel preparation with either sennosides and rectal washout (S + RWO; n = 26) or polyethylene glycol and a balanced electrolyte solution (PEG + E) given orally (n = 25) or by nasogastric infusion (n = 26) have been studied. PEG + E was not associated with significant physiological change in electrolytes or blood gases. ⋯ It is therefore a safe, quick and efficient bowel preparation and provides a safer alternative to mannitol. The solution (PEG + E) man be used orally or by nasogastric infusion and does not require an accompanying intravenous infusion.
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The choice of fluid for resuscitation in severe shock remains controversial. The various solutions commercially available have been compared in a standardized canine refractory shock model. The use of colloidal solutions proved preferable to the use of crystalloid solutions alone, as judged by oxygen debt, the volume required and the evidence of pulmonary overload. ⋯ The clinical absence of reported serious side effects would suggest that Haemaccel is likely to be the colloidal fluid of choice. However, in the model studied, the use of a mixture of crystalloid and colloid produced results that were significantly better than either crystalloid or colloid alone. It is concluded that much of the controversy between crystalloid and colloid is artificial and that a mixture of these substances will be required in the resuscitation of the severely shocked patient.