RESUMEN

Previous studies report a wide range of prevalence rates of depressive illness among general hospital inpatients, all higher than in a non-patient population. Several factors may have influenced on these results. Mixed study population, depression-prone subgroups and continuous shift in what is a surgical inpatient population due to day surgery treatment are examples. In the present study, 108 patients were assessed with the Structured Clinical Interview for DSM-III-R Non-Patient (SCID-NP) version for current major depression (CMD) and for dysthymia. Furthermore, a patient self-rating scale for depressive symptoms and anxiety, the Hospital Anxiety and Depression Scale (HADS), was applied. CMD was diagnosed among 14/108 patients (13%). Depressive symptoms (HADS-D> or =8) were seen in 14 patients. Symptoms of anxiety (HADS-A> or =8) were seen in 12/14 CMD patients (86%). Ten of the 14 patients diagnosed as CMD (71%) did not receive any pharmacological antidepressant treatment. After excluding known depression-prone subgroups of patients representing a bias, this study showed that in a community hospital group of adult surgical patients between 18 and 65 years of age, the prevalence of depression is still somewhat higher than in the general population, but not as high as in the previous studies on general hospital patients to which we referred. Thus, this high prevalence of depression in part could be due to increased depression rates in certain population subgroups. However, this hypothesis alone is not sufficient to explain the present results fully.

Asunto(s)

RESUMEN

Pneumoscrotum is a rare condition which may accompany retroperitoneal ruptures of air-filled gastrointestinal organs, endoscopic and surgical procedures and widespread subcutaneous emphysema. A case of pneumoscrotum as a complication to treatment of tension pneumothorax is reported, and the literature is reviewed.

Asunto(s)

RESUMEN

We report on a series of 193 patients with traumatic liver injuries treated at our Trauma Centre I during the period 1983-94; i.e. about 13 patients per year. The centre has a catchment population of 850,000. Most of the patients were severely injured, with 3.2 injured organs per patient among the 151 patients with multiple injuries. The clinical diagnostic work was supplemented with peritoneal lavage, ultrasonography and computer tomography. 38 patients were not operated on, of whom 25 survived. Exploratory laparotomy with or without liver suturing was used in 125 patients and liver resection in 18 seriously injured patients, with more than 50% mortality. Perihepatic packing was used in 12 patients, all with other serious injuries and with a high rate of mortality from these injuries. Liver injuries can be divided into two groups. A few injured patients are admitted in severe shock, and may be treated with immediate thoracotomy and clamping of the aorta, followed by urgent laparotomy to control bleeding by means of packing. The rest of the abdomen is examined quickly and closed, to avoid well known complications of bleeding and multitransfusions, i.e. hypoxaemia, acidosis and hypothermia. Repeat laparotomy follows in 2-3 days, to remove the packing. A stable patient should be referred for computer tomography, and may be treated without operation, but must be followed closely clinically.

Asunto(s)

Asunto(s)

RESUMEN

This paper describes the basic physical aspects of electricity and the harmful effects of electric shock to the various human organ systems. Treatment of electrical injuries differs from treatment of burns. Damage to muscles and subcutaneous structures necessitates a more aggressive fluid replacement regimen than the one predicted by the commonly used burn fluid resuscitation formulas. It is of paramount importance to avoid renal complications. Early fasciotomy and repeated surgical debridements are often necessary. Routine arrhythmia-monitoring is now considered unnecessary in individuals exposed to low tension alternating current unless arrhythmias requiring treatment are present at the primary medical contact.

Asunto(s)

RESUMEN

We review a patient material consisting of cases with electrical injuries submitted to Sentralsykehuset i Akershus, Norway over a period of ten years. 18 cases were treated during the period 1 January 1978 to 31 December 1987. All were men, with a mean age of 33 years. All injuries were caused by AC current; seven were low voltage, and 11 high voltage injuries. The low voltage injuries proved to be relatively innocent, but 2/11 with high voltage injuries died. Many of the high voltage patients had severe deep tissue, mainly muscular, damage. The two who died had respiratory arrest, were unconscious on admission and had cardiac arrest. Only one with cardiac arrest on admission and two with respiratory arrest survived; three of the five who were unconscious on admission survived. Optimal treatment of injuries caused by electricity requires a thorough understanding of the special pathophysiology of this condition.

Asunto(s)

RESUMEN

We have treated 14 patients with acute arterial thrombosis with intravenous infusion of streptokinase using a standard dosage scheme. The indication for treatment was critical ischemia due to arterial thrombosis and a presence of symptoms for less than 30 days. The arteriography showed no possibility of reconstructive vascular surgery. The results showed that this treatment is not a good alternative for this group of patients. On the same indications we also treated two patients with intra-arterial infusion of streptokinase at a dosage of 5,000 U per hour. Successful thrombolysis was achieved in both patients. Arteriograms demonstrated that the small distal vessels were opened, along with the femoro-popliteal segment, which showed significant stenosis. The patients could then be helped by reconstructive vascular surgery. We conclude that thrombolysis with intra-arterial infusion of streptokinase is a good choice as the initial treatment for this group of patients. However, the follow-up must include immediate reconstructive vascular surgery or radiological treatment with PTA.

Asunto(s)

RESUMEN

Following operation for aneurysm of the abdominal aorta two patients developed buttock necrosis. One procedure was elective and one was an emergency procedure. Patient 1 in addition developed paralysis of the leg on the same side as the buttock necrosis, while patient 2 in addition developed colon ischemia. Both patients died from these complications. Buttock necrosis and paralysis are rare complications after operation for abdominal aortic aneurysm. Regional ischemia of the left colon is a more common complication. The case report illustrates the importance of the pelvic-femoral collaterals. In addition we emphasize the importance of maintaining or restoring hypogastric circulation in order to prevent these complications.

Asunto(s)

RESUMEN

The Late Effect of Accidental Injury Questionnaire (LEAIQ) is a self-report questionnaire constructed to assess the biological, psychological and social effects of traumatic injuries. The LEAI covers current civil and employment status (4 questions); possible negative or positive consequences of the injury (20 questions) symptoms of post-traumatic distress (24 questions); aspects of the accident situation and the emotional impact of the trauma considered to be of relevance for the development of post-traumatic stress disorder and litigation behaviour (3 questions). The last part of the LEAIQ deals with the patient's opinion about the hospital treatment and follow-up control and self-perceived current medical or social needs (4 questions). Preliminary data on reliability and validity are reported from two studies investigating a total of 640 accidentally injured adults. The data indicate that the LEAIQ is easy to fill in for the patients and provides fairly good estimates of the frequency of the long-term biological, psychological and social effects in a sample of accidentally injured adults. The data on sensitivity and negative predictive power further suggest that the LEAIQ should be suitable in clinical practice as a first-step instrument for screening late effects of trauma.

Asunto(s)

RESUMEN

The negative biological, psychological and social outcomes following accidental injuries were assessed after three years in 551 adults by questionnaires, medical records and information from the National Insurance Offices. Fifty-four percent reported at least one negative outcome. Some reduction of physical function was reported by 31.8% and worsened bodily health by 26.0%. In about half of these cases reduced life quality was the main problem. Of the persons 18.9% claimed worsened psychological health and 18.2% decreased capacity for work as an effect of the injury. It is concluded that accidental injuries are an important source of morbidity and reduced life quality in society and that the long-term outcomes are best conceived within a biopsychosocial frame of reference.

Asunto(s)

Asunto(s)

RESUMEN

One hundred and twelve adults admitted to a surgical ward due to accidental injuries were studied. Thirty-seven percent had a psychiatric disorder on admission (DSM-III axis I) and 21% had a personality disorder (axis 2). Substance abuse and dependence and antisocial personality disorders were most frequent. Eighteen percent were definitely distressed when injured. Persons with a personality disorder were distressed significantly more often and had sustained clinically more severe injuries. No support could be found for a hypothesis of accidental injuries being the result of hidden or unconscious self-destructive tendencies, and only one patient was injured in a suicide attempt. Defense Mechanism Test applied to a subgroup of 20 patients suggested that high perceptual defense may be related to injury occurrence in patients at fault for the accident.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

In 81 patients with acute abdominal pain, laparoscopy was performed because of diagnostic doubt. Diagnosis by clinical methods proved to be correct in 42 of the patients and laparoscopy gave correct diagnosis in 70. Appendectomy revealed acute appendicitis in 19 patients and normal appendix in five. Failure to establish a diagnosis by laparoscopy was due to incomplete visualization of appendix in nine patients, pelvic adhesions in one patient, and failure to enter the peritoneal cavity in another. A clinical diagnosis of acute appendicitis could be invalidated by laparoscopy in 17 of 40 patients. Negative laparotomy is potentially avoidable by use of laparoscopy when a diagnosis of appendicitis is questionable. Laparoscopy may therefore be warrantable in such cases.

Asunto(s)

RESUMEN

In this series of 80 consecutive patients with injured spleens scintigraphy was the diagnostic mainstay and was performed in 63 patients. Fifty-five patients were initially managed without operation. Two of them, however, underwent laparotomy respectively 1 and 2 days after admission because of increasing symptoms and signs. Twenty-seven patients underwent laparotomy, with successful conservative surgery in 8 and splenectomy in 19. However, in at least five of these it was thought in retrospect that repair of the spleen might have been possible. There were no deaths or serious morbidity from the injury to the spleen. It is concluded that no operation or operative repair of the spleen is the treatment of choice in the majority of patients with blunt injuries. In order to avoid loss of life as well as loss of the spleen, strict adherence to an aggressive, exact diagnostic process, using non-invasive diagnostic imaging and close clinical observation, as well as experienced, painstaking surgical techniques, is necessary.

Asunto(s)

Asunto(s)

Asunto(s)