Annales chirurgiae et gynaecologiae
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Clostridial gas gangrene and perineal necrotizing fasciitis or Fournier's gangrene are rare but serious infections with an acute onset, rapid progression, systemic toxemia and a high mortality rate. The aim of this study was to investigate the efficacy of surgery, antibiotic treatment, surgical intensive care and in particular the role of hyperbaric oxygen (HBO) in the management of these infections. An experimental rat model was used to investigate the possibilities for measuring tissue oxygen and carbon dioxide tensions during hyperbaric oxygen treatment. ⋯ When examining the subcutaneous PO2 levels measured from patients with necrotizing fasciitis, the PO2 was regularly higher in the vicinity of the infected area than in healthy tissue. In general, HBO treatment resulted in a marked increase in tissue oxygenation in both healthy tissue and in the vicinity of infected tissue. The hyperoxygenated tissue zone surrounding the infected area may be of significance in preventing the extension of invading microorganisms.
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Preoperative diagnosis of blunt diaphragamatic rupture is difficult and missed injuries can lead to severe late complications. The aim of this study was to assess the value and reliability of initial chest radiographs in diagnosing blunt diaphragmatic rupture. ⋯ In spite of the availability of newer diagnostic imaging techniques, the initial chest radiograph is very reliable in detecting most cases with blunt diaphragmatic rupture, and together with high index of suspicion and sound clinical assessment remain the cornerstone in diagnosing these challenging injuries.
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The following guidelines are recommended in the management of malignant melanoma. An excisional biopsy is the appropriate diagnostic procedure for a skin lesion suspected of being a melanoma. The advised margin for diagnostic excision is 2 mm of macroscopically normal skin around the lesion; the margins for therapeutic excision are 1 cm of normal skin for a lesion with a Breslow thickness of < 2 mm and 2 cm when the Breslow thickness is > 2 and < or = 4 mm. ⋯ Regular routine blood tests and radiological examinations are not considered to be worthwhile. There is no evidence that the growth of micro-metastases is stimulated by hormonal changes during pregnancy or contraceptive pill use. Excessive exposure to ultraviolet radiation should be discouraged.
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Open reduction and internal fixation of an extensively swollen ankle may lead to wound closure problems, blistering, wound edge necrosis and infection. Accordingly, internal fixation should be accomplished either before or after the period of critical soft tissue swelling. The object of the study was to investigate if the timing of surgery had any influence upon soft tissue complications and hospital stay. ⋯ Delayed surgery of closed ankle fractures increases the risk of soft tissue complications and prolongs hospital stay. Immediate surgery is particularly indicated in the severely displaced ankle fracture, and if not achievable, temporary reduction and immobilization is recommended.
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The incidence of achilles tendon (AT) ruptures is increasing. The aim of the present study was to evaluate annual incidence, aetiology, operative complications and direct hospital costs of AT ruptures. ⋯ The incidence of AT ruptures is increasing in South-East Finland. The rate of major surgical complication was low (4.5%) and comparable with earlier studies.