ye le pansay, Dieu le guarit ' -AMBRO' I' SE PAR6 (I 5 10-1 590) SUMMARY This paper relates the results of a clinical investigation into the value of suction drainage in general surgery which has covered 5 years and was conducted under some measure of control.The number of drained wounds observed is 1193; the results obtained show that the method produces great improvement in the healing of operations on the genito-urinary tract. In operations on the breast and thyroid, in herniotomies in which drainage has been indicated, and in a miscellaneous group, some improvement has been noted clinically. In the biliary tract fringe benefits have also occurred, but in these five groups statistical analysis of the figures obtained has not disclosed truly significant differences.It has not been found satisfactory in operations involving the lumen of the alimentary tract or in cases where frank infection with purulent exudate was present at operation.The results of two other investigations are also shown. One related to comparative studies of Lugol's solution, iodophor solution, and antibiotic sprays as methods of preoperative preparation, and the other to the time of the preliminary preoperative skin preparation and the effect this may have on wound healing.
DAMAGE to the bladder and urethra has been generally believed to be a common complication of fracture of the pelvis. However, recent reports (Holdsworth, 1963; Mitchell, 1964) indicate that only 3-5 per cent of patients with a fracture of the pelvic ring have complicating lower urinary tract damage. Rupture of the membranous urethra is approximately five times more common than rupture of the bladder: a combination of bladder and urethral injury occurs occasionally.Damage to the rectum is a n unusual complication of pelvic fracture. When this occurs it usually takes the form of a simple puncture of the bowel, although sometimes the displaced bony fragments may cause a partial or a complete tear of the rectal wall.T h e purpose of this paper is to report a patient who sustained a classic rupture of the prostatomembranous urethra i n association with an unusual injury of the rectum and anal canal. CASE REPORTA qg-year-old farm worker fell in front of a caterpillar tractor which passed across his body as he lay supine on soft ground. He was admitted to hospital pale and sweating, bleeding from wounds in the right thigh, perineum, and buttocks, and complaining of severe lower abdominal pain. No urine had been passed since the accident.His blood-pressure was recorded as 75/40 and pulserate 104 per nun. Tenderness was present in the hypogastrium; bowel-sounds were audible and there was no guarding of the abdominal muscles. In the right groin a rz-in.-long wound was present and the adductor muscles were extensively damaged. A second wound was present in the perineum where the skin had been completely torn from the margin of the anus, which, with the anal canal, sphincters, and rectum, had retracted upwards z in., giving the impression that the anus and anal canal had I:IG. 2.-Radiograph of lower pelvis demonstrating eversion of the ischial fragments.disappeared. This wound was linear and extended across the perineum to the tip of the coccyx.Figs. I, z show the bony damage as seen on radiographs of the pelvis. There are bilateral symmetrical fractures of the superior pubic rami and of the ischiopubic rami. The ischiopubic fractures show a curious eversion of the fragments. The fracture of the right ischium is comminuted and the fracture lines extend to the acetabulum. There is no radiological evidence of damage to sacrum, ilium, or sacro-iliac joints.A diagnostic catheter passed easily but failed to withdraw urine. The catheter and fractured ischial bones were palpable in the perineal wound.After infusion of z pints of plasma and transfusion with 3 pints of blood, a general anaesthetic was induced and operation began: during operation a further 7 pints of blood were given.OPERATION.-The peritoneal cavity was opened through a vertical hypogastric incision and an intraperitoneal lesion excluded. The retropubic space was then explored. The bladder was distended and contained clear urine. A
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