Selective management of penetrating neck injuries based on clinical presentations is safe and practical.

Selective management was offered in 57 patients who had penetrating injury to the anterior neck. During the study period, decision making in patient management at our institution depended largely on clinical presentations. Indications for neck explorations were unstable hemodynamics, airway obstruction, active bleeding from the wound, and evidence of aerodigestive tract injuries. Some patients with deep wounds of zone II also underwent neck explorations. Investigations were performed in selected cases. With this selective policy, there were two unnecessary operations among 40 patients (70.2%) who underwent neck exploration. Both of them were operated because of deep wounds of zone II. The remaining 17 patients (29.8%) had uneventful conservative treatment. There was no mortality in this study. The authors concluded that selective management of penetrating neck injuries based on clinical presentations is safe and practical.

Surgery of the abdominal aorta: experience of a university hospital in Thailand.

One hundred and thirty two patients who underwent aortic surgery at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 1991 to December 2000 were studied. Twenty three patients (17.4%) were aged less than 60 years, 102 (77.3%) aged 60-80 years, and 7 (5.3%) were older than 80 years. Ninety eight patients (74.2%) underwent elective operations and 34 (25.8%) underwent emergency operations. Elective abdominal aortic aneurysms (AAA) repair was the most common indication for abdominal aortic surgery (56.0%). Eighteen patients (13.6%) underwent surgery for infected AAA. The incidence of infected AAA was 16.1 per cent among patients with AAA. Fifteen patients (11.4%) had ruptured AAA and 19 patients (14.4%) had aortoiliac occlusive disease. The overall mortality rate was 15.2 per cent. The mortality of elective aortic surgery was 5.1 per cent and of emergency aortic surgery was 44.1 per cent. The mortality of elective AAA repair was 4 per cent. Multiple system organ failure was the most common cause of death (80%), followed by acute myocardial infarction (10%) and exsanguination (10%). The authors conclude that elective surgery on the abdominal aorta is safe and should be performed when indicated to prevent the development of complications requiring emergency surgery which carries a much higher risk.