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Gunshot wounds of the trunk
69
Abstracts
venous thrombosis and pulmonary embolism published in 1968 are restated. The incidence of these conditions in 234 patients similarly injured and treated in the last 5 years is presented and analysed. On the basis of a clinical diagnosis 17 per cent had venous thrombosis, 10 per cent suffered pulmonary embolism and 2-5 per cent (6 patients) died from this cause. In each of these categories there was a striking increase in the incidence over that reported in 1968. No prophylactic anticoagulant therapy had been used in these patients. Emphasis was placed on the importance of early diagnosis of venous thrombosis and immediate institution of anticoagulant therapy. On the basis of the figures presented it is concluded that the prophylactic use of anticoagulants is not justified. WATSON N. (1974) Anticoagulant therapy in the treatment of venous thrombosis and pulmonary embolism in acute spinal injury. Paraplegia 12, 197.
reliably as one within the peritoneal cavity. The exteriorization must be done through a generous incision and the fascia of the abdominal wall must be sewn across through a window in the mesocolon instead of the conventional colostomy rod. KIRKPATRICKJ. R. and RAIPAL S. G. (1973) The management of penetrating wounds of the colon. Surg. Gynecol. Obstet. 137, 484. Gunshot
wounds
of the trunk
Conditions in Belfast have made it possible for patients to reach hospital in time for rapidly exsanguinating injuries to be treated successfully and have added emphasis to the need for prompt and vigorous resuscitation followed by bold, knowledgeable surgical measures. The authors’ experience has led them to believe that when the right sort of experience and facilities are readily available, thoracotomy is an operation to be performed readily rather than reluctantly or as a last resort. The emphasis is on diagnosis Thoracic and abdominal injuries and repair, and they carried out few lobectomies and no pneumonectomy. They discuss the difficulties of Traumatic haemobilia surgical approaches to wounds in the region of the Two cases are described of blunt injury to the liver inlet of the thorax. developing into a large cyst containing blood, and About 1 casualty in 40 had an abdominal injury necrotic liver tissue. The common symptom was and 16 of the 120 died. The chief lessons were to gastro-intestinal bleeding, developing 3 months after re-emphasize the importance of removing pulped injury in one case and after 2 weeks in the other. liver by ad hoc rather than formal hepatectomy, of Hepatic arteriography revealed the lesions. The repairing small intestine and of colostomy in the literature is surveyed. treatment of wounds of the coIon. Repair is practicMCGEHEER. N., TOWNSENDC. M. jun., THOMPSON able and safe only for small, tidy wounds of the right J. C. and FISH J. C. (1974) Traumatic haemobilia. side of the colon. Ann. Surg. 179, 3 11. STEVENSON H. M. and WILSONW. (1975) The surgery of violence: VII. Gunshot wounds of the trunk. Long-term ventilation Br. Med. J. 1, 728. Using arterial PO, as the criterion, the performance of various mechanical respirators was compared. Fractures and dislocations Volume-limited respirators gave better results than Fractures of the medial epicondyle in children the pressure-limited machines. They also resulted in A review of 50 children with fractures of the medial better tidal volume and compliance and less atelecthumeral epicondyle brought out the following points. asis. This process is applicable to head and chest The fractures are almost always associated with disinjury treatment. locations of the elbow, many of which reduce sponFLEMINGW. H. and BOWEN J. C. (1972) A comparative evaluation of pressure-limited and volumetaneously. Treatment with a sling gave good results only in 90 per cent, open reduction was followed by limited respirators for prolonged postoperative 75 per cent good results. When the dislocation ventilatory support in combat casualties. Ann. Surg. required reduction without fixation of the fracture, 172, 49. good results followed in 72 per cent while closed reduction of the dislocation followed by open reducAbdominal injuries in children tion of the fracture (7 examples) gave good results in An analysis of a series presenting at one hospital, only 50 per cent. The authors conclude that operation including the frequency of involvement of the various is not justified unless the ulnar nerve is involved or the organs, associated injuries and clinical findings. fracture fragment is intra-articular and displaced. RICHARDSONJ. D., BELINR. P. and GRIFFINW. 0. BEDE W. B., LEFEBUREA. R. and ROSMANM. A, (1972) Blunt abdominal trauma in children. Ann. (1975) Fractures of the medial humeral epicondyle Surg. 176, 213. in children. Can. J. Surg. 18, 137. A technique
for wounds
of the colon
There are disadvantages to both colostomy and primary closure. The operation described is based on the concept that an exteriorized anastomosis heals as
Interpretation
of X-rays
in elbow
injuries
Additional radiological signs in the abscence of visible fractures in elbow injuries are sometimes helpful. Hunter, from Cincinnati, draws attention to
Abstracts
venous thrombosis and pulmonary embolism published in 1968 are restated. The incidence of these conditions in 234 patients similarly injured and treated in the last 5 years is presented and analysed. On the basis of a clinical diagnosis 17 per cent had venous thrombosis, 10 per cent suffered pulmonary embolism and 2-5 per cent (6 patients) died from this cause. In each of these categories there was a striking increase in the incidence over that reported in 1968. No prophylactic anticoagulant therapy had been used in these patients. Emphasis was placed on the importance of early diagnosis of venous thrombosis and immediate institution of anticoagulant therapy. On the basis of the figures presented it is concluded that the prophylactic use of anticoagulants is not justified. WATSON N. (1974) Anticoagulant therapy in the treatment of venous thrombosis and pulmonary embolism in acute spinal injury. Paraplegia 12, 197.
reliably as one within the peritoneal cavity. The exteriorization must be done through a generous incision and the fascia of the abdominal wall must be sewn across through a window in the mesocolon instead of the conventional colostomy rod. KIRKPATRICKJ. R. and RAIPAL S. G. (1973) The management of penetrating wounds of the colon. Surg. Gynecol. Obstet. 137, 484. Gunshot
wounds
of the trunk
Conditions in Belfast have made it possible for patients to reach hospital in time for rapidly exsanguinating injuries to be treated successfully and have added emphasis to the need for prompt and vigorous resuscitation followed by bold, knowledgeable surgical measures. The authors’ experience has led them to believe that when the right sort of experience and facilities are readily available, thoracotomy is an operation to be performed readily rather than reluctantly or as a last resort. The emphasis is on diagnosis Thoracic and abdominal injuries and repair, and they carried out few lobectomies and no pneumonectomy. They discuss the difficulties of Traumatic haemobilia surgical approaches to wounds in the region of the Two cases are described of blunt injury to the liver inlet of the thorax. developing into a large cyst containing blood, and About 1 casualty in 40 had an abdominal injury necrotic liver tissue. The common symptom was and 16 of the 120 died. The chief lessons were to gastro-intestinal bleeding, developing 3 months after re-emphasize the importance of removing pulped injury in one case and after 2 weeks in the other. liver by ad hoc rather than formal hepatectomy, of Hepatic arteriography revealed the lesions. The repairing small intestine and of colostomy in the literature is surveyed. treatment of wounds of the coIon. Repair is practicMCGEHEER. N., TOWNSENDC. M. jun., THOMPSON able and safe only for small, tidy wounds of the right J. C. and FISH J. C. (1974) Traumatic haemobilia. side of the colon. Ann. Surg. 179, 3 11. STEVENSON H. M. and WILSONW. (1975) The surgery of violence: VII. Gunshot wounds of the trunk. Long-term ventilation Br. Med. J. 1, 728. Using arterial PO, as the criterion, the performance of various mechanical respirators was compared. Fractures and dislocations Volume-limited respirators gave better results than Fractures of the medial epicondyle in children the pressure-limited machines. They also resulted in A review of 50 children with fractures of the medial better tidal volume and compliance and less atelecthumeral epicondyle brought out the following points. asis. This process is applicable to head and chest The fractures are almost always associated with disinjury treatment. locations of the elbow, many of which reduce sponFLEMINGW. H. and BOWEN J. C. (1972) A comparative evaluation of pressure-limited and volumetaneously. Treatment with a sling gave good results only in 90 per cent, open reduction was followed by limited respirators for prolonged postoperative 75 per cent good results. When the dislocation ventilatory support in combat casualties. Ann. Surg. required reduction without fixation of the fracture, 172, 49. good results followed in 72 per cent while closed reduction of the dislocation followed by open reducAbdominal injuries in children tion of the fracture (7 examples) gave good results in An analysis of a series presenting at one hospital, only 50 per cent. The authors conclude that operation including the frequency of involvement of the various is not justified unless the ulnar nerve is involved or the organs, associated injuries and clinical findings. fracture fragment is intra-articular and displaced. RICHARDSONJ. D., BELINR. P. and GRIFFINW. 0. BEDE W. B., LEFEBUREA. R. and ROSMANM. A, (1972) Blunt abdominal trauma in children. Ann. (1975) Fractures of the medial humeral epicondyle Surg. 176, 213. in children. Can. J. Surg. 18, 137. A technique
for wounds
of the colon
There are disadvantages to both colostomy and primary closure. The operation described is based on the concept that an exteriorized anastomosis heals as
Interpretation
of X-rays
in elbow
injuries
Additional radiological signs in the abscence of visible fractures in elbow injuries are sometimes helpful. Hunter, from Cincinnati, draws attention to