Causes of death of patients with multiple injuries in Debrecen, Hungary.

OBJECTIVE: To find out the main causes of death of people who had multiple severe injuries. DESIGN: Retrospective study. SETTING: Teaching hospital, Hungary. SUBJECTS: 86 people with severe multiple injuries, of whom 59 died and had necropsies. MAIN OUTCOME MEASURE: Establishment of a database. RESULTS: Consumption of alcohol was a common precursor. Head and chest injuries predominated. More pedestrians than people in vehicles were killed, and there were 8 suicides and 3 murders. There were no gunshot injuries. CONCLUSIONS: Reduction of deaths from multiple injuries is as much a socioeconomic as a medical matter.

[Calculated gastric intramucosal pH changes in the early phase of acute pancreatitis]. / Számított intramucosalis pH-változások a gyomorban az akut pancreatitis kezdeti szakaszában.

Based on the literature dysfunction of splanchnic circulation may be assumeol in the development of severe acute pancreatitis. Abnormal gut functions investigated by routinely used clinical examination is not available. Gastric tonometry indirectly gives information about gut function. Authors followed prospectively 12 patients who suffered from acute pancreatitis. Four patients recovered without complications, 4 patients had different complications and 4 patients died. Gastric intramucosal pH (pHi) was measured by TRIP NGS catheter and Tonocap monitor. Measurements were started at the time of hospitalisation and repeated every six hours on the first 3 days. Intramucosal acidosis (pHi < 7.3) could be measured independently from aetiology. Gastric pHi showed strong correlation with Acute Physiology and Chronic Health Evaluation II. (APACHE II) score (p = 0.02). APACHE II scores were significantly higher in-group pHi < 7.2 (13.9 +/- 1.7) compared to group pHi > 7.2 (7.33 +/- 1.06) (p = 0.002). 24-hour changes in APACHE II scores were significantly greater in the cases of pHi < 7.2 (3.3 +/- 1.47) versus pHi > 7.2 (-0.6 +/- 0.97) (p = 0.03). Changes of pHi in the early phase of acute pancreatitis indicate that splanchnic circulation is already involved and the pHi may have a prognostic value.

Treatment of ingrowing toenail with segmental chemical ablation.

During a 5 year period (1992-1996) 716 segmental chemical ablations using phenol solution of 80 v/v % were carried out because of ingrowing toenail. As a control, Emmert procedure was done in 200 cases. In the present study we discuss the etiology, the surgical technique of the chemical ablation and the results of the intervention. We have found that phenol treatment results in a larger rate of symptomatic relief, lower recurrence rate and better cosmetic results could be achieved. Taking into account the good results, the low financial requirements of the procedure in the treatment of ingrowing toenail, segmental chemical ablation with phenol may be the therapy of choice of the disease.

Shall we wait until the head of the femur is completely crushed in idiopathic necrosis of the femoral head?

Although it is of polyetiological nature but of identical pathomechanism, the necrosis of the femoral head has been known for more than a century, and, without treatment, it results in complete necrosis. To stop the progression of the process, load-lifting drilling of the affected area was introduced in the 1970s. Since then, the success of the technique in the early stage of the disease has been justified by countless follow-up examinations and studies. Load-lifting drilling of the affected area in the early stage of the disease yielded similar results at our department in a small clinical sample over 6 years. To ensure permanent drainage, we have used cannulated titanium screws with a diameter of 9 mm for the second year now; besides allowing continuous decompression these screws hold mechanically well and the use of titanium allows MR and CT investigations later on.

Thoracoscopic lung resection by the help of Nd:YAG laser.

The Swedish surgeon Jacobaeus was the first to use a lighted cystoscope for the lysis of pleural adhesions /5/. The same author reported, in 1921, five cases of intrathoracic malignancies diagnosed by thoracoscopy /6/. After the appearance of video-assisted cholecystectomy and abdominal surgery, video-assisted thoracic surgery (VATS) also occupied a major share in thoracic surgery. It was long ago that we introduced a thoracoscope (not the video-assisted type) for thoracic intervention. In 1988 we published 24 cases of thoracic sympathectomies in which we used the thoracoscope /16/.

[A point system (Trauma Score) in the classification of injuries in emergency care]. / Osztályozó pontrendszer alkalmazása a sérültellátásban.

essence of the modified variation of AIS scheme made suitable for data processing, for the application of which the so called "AIS vocabulary" is necessary. In their Department the severity of injury of all patients has been assessed in a routine way, on the basis of scoring systems since 01.07.1987. Their experience obtained in the field of scoring poly- and multi-traumatized patients is reported. In their opinion knowing and applying scoring systems give valuable information not only from the point of view of the practice of casualty attendance and prognosis to be predicted but for objective financial assessment too.

[Traumatic hip dislocation in childhood]. / Gyermekkori traumás csípöficam.

Authors describe the diagnostic and therapeutic problems of the traumatic dislocation of the hip in children and report on the experiences of their 8 cases. It is stressed that the condition of the good result in the early diagnosis and reduction. For the recognition and treatment of the late complications a 1.5-2 years follow-up of the patients is thought to be important.

[A point system for the comparative evaluation of the treatment of acromioclavicular dislocations]. / Pontrendszer az acromioclavicularis ficamok kezelésének összehasonlító értékelésére.

Authors treated 165 patients for fresh acromioclavicular dislocation. In the period examined four different operative procedures were used for the transitory fixation of the joint. The results of treatment are assessed with a point system worked out by them. Their method makes the establishment of collective statistics, based on uniform points of view and extended to more institutions possible. By this an objective comparison on the effectiveness of the single conservative and operative methods of treatment will be practicable.

[Hand fractures and epiphyseal injuries in childhood]. / Gyermekkori kéztörések és epiphysis sérülések.

Anatomic features of the hand in childhood are presented that are responsible for the types of certain injuries. On the basis of the data in the literature and of the authors' own experience of 92 cases the main points of the diagnosis and therapy of metacarpal and phalanx fractures are summarized. The possibility of finger-replantation is also mentioned. Their statements are illustrated by their own cases. In order to recognize late growth disturbances, the necessity of the follow up is emphasized.

[Stabilization of the injured acromioclavicular joint using a new type of fixation plate]. / A sérült acromioclavicularis ízület stabilizálása új típusú rögzítölemezzel.

The opinions in the question of transitory fixation of the joint during the treatment of the acromioclavicular articulation are rather different. The complications of the widely used methods--break of the implant, its tear from the bone, the wandering and the disturbances of wound healing--are well known. To decrease the number of complications authors have developed a new type of hooked plate. The plate is fitted to the anterior surface of the acromial end of the clavicle and its hook is fixed from below in the bore hole of the acromion. To choose the optimal place of the bore hole a drill guide was prepared. The operative method is described and the advantages of the method are summarized. The "Debrecen-plate" was used during 2 years in 39 injuries. 35 patients were controlled 6-24 months after the operation. Based on the results of the treatment a wider use of the method is suggested.

[Classification of the condition of accidental injuries in children by grading]. / Gyermeksérültek állapotának megítélése pontrendszerekkel.

The authors give a brief survey of the point system used in the classification of injuries. They present the evaluation of the polytraumatic and seriously injured patients of their department accept during a period of two and half years. The results are compared with the material of children recorded during a five years period. They describe the point system used in the classification of children's injuries (PTS) and point out that the TS and ISS system used with adult patients are suitable for numerical determination of the condition of injured children.