Canadian journal of surgery. Journal canadien de chirurgie
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The long-term complications of diabetes mellitus occur despite insulin therapy. One of these complications is gangrene of an extremity which is a prime cause of morbidity and mortality in diabetic patients. ⋯ The author describes six diabetic patients with gangrene of an extremity treated at the Riverside Hospital in Ottawa to illustrate how this condition may be managed by revascularization with no amputation or with conservative amputation and debridement. Major amputation was avoided in all six patients.
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Subdural empyema is a surgical emergency, which, if not recognized and managed promptly, is rapidly fatal. The clinical features, diagnosis, infecting organisms, treatment and results in 15 patients with subdural empyema admitted to the University and Saskatoon City hospitals between 1956 and 1982 are evaluated. There were 11 males and 4 females; 80% were under 50 years of age. ⋯ Follow-up ranged from 1 month to 15 years. Eleven patients recovered with minimal or no neurologic deficit, 2 patients had permanent major deficits and 2 died. Successful management of subdural empyema depends on early diagnosis, prompt evacuation of the pus and appropriate antibiotic therapy.
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Cardiac tamponade is a well-known result of fluid collection within the pericardial sac. That air in the pericardial sac can produce a similar clinical picture is not so well known. The author describes the case of a 38-year-old patient with acute cardiac tamponade produced by air within the pericardial sac after trauma.
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Three cases of immobilization hypercalcemia are presented and the incidence, clinical symptoms, laboratory investigation, pathophysiology and treatment of this metabolic abnormality are reviewed. Immobilization hypercalcemia is more common that has previously been suspected. Vague clinical symptoms may not suggest the diagnosis of hypercalcemia. ⋯ Treatment is directed towards lowering the serum calcium level using intravenous hydration, furosemide and salmon calcitonin. Definitive treatment consists of mobilizing the patient. Exercises in bed have not been effective in preventing or treating immobilization hypercalcemia.
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Possible intra-abdominal injuries were sought in 101 patients admitted with blunt abdominal trauma. The serum amylase level was measured in the first 12 hours after the accident. ⋯ The mean value of the serum amylase for those who had laparotomy was 1190 IU, while it was only 363 IU for those not operated upon. The authors conclude that hyperamylasemia in blunt abdominal trauma is not specific to pancreatic injury, but may suggest the presence of a serious intra-abdominal lesion.