Videoconferencing for gynaecological cancer care: an international tumour board.
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Biomedical subjects
Publications and source records attributed to J Farbstein.
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Colonic injuries are usually treated by exteriorization, resection and colostomy, or primary repair with proximal colostomy. However, many cases of successful treatment of colonic wounds by primary suture without colostomy have been reported. Yet, these repairs are usually restricted to civilian injuries, stab wounds, perforations of the right colon, cases with few or no other organ injuries, a short time interval between injury and operation, absence of shock, and minimal fecal soiling. We considered lack of fecal spillage to be the only important factor for 12 consecutive patients, the majority war casualties, and performed primary colon repairs on them. All the other commonly accepted limiting factors were disregarded. There were no complications related to the bowel repair. Using these more liberal guidelines, the number of primary repairs of colonic injuries may be increased, thus reducing hospitalization time and cost, and more important, reducing morbidity and mortality associated with the creation and subsequent closure of colostomies.
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A case of axillary vein thrombosis in a young man was treated by means of a cephalic vein cross-over bypass graft. A temporary arteriovenous fistula performed in the antecubital fossa resulted in a reasonable enlargement of the graft and prevented its occlusion in the critical postoperative period until healing of the intima resulted. The swelling disappeared and the patient, who was completely incapacitated functionally prior to the operation, resumed normal activity.
1) In major vein trauma, an attempt should be made to repair the vein. 2) Whenever possible, lateral suture seems to be the ideal type of repair. However, excellent results can be obtained with end-to-end anastomosis. 3) When the damaged segment of the vein is too long to permit end-to-end approximation, a vein interposition graft (and if necessary, a composite tube) appropriate to the width of the injured vein and length of the gap should be employed. Use of synthetic grafts should be avoided. 4) Although the importance of a distal temporary A-V fistula is still disputed, the present authors have adopted this method in the graft repair of the femoral vein in the groin. Better results were obtained in the cases in which the fistula functioned than in those in which it became occluded.
Two patients with spontaneous aortocaval fistula due to a ruptured aortic abdominal aneurysm are described. This accident is one of the rarest complications of such an aneurysm and is a severe surgical emergency with widely varying symptoms. Although its recognition should be obvious, it poses both diagnostic and therapeutic problems. One of our patients survived following 45 days of hemodialysis treatment.