Resuscitative thoracotomy after stab heart injury. Two cases of tamponade, managed in a rural hospital

Two trauma cases are presented which were managed in a rural hospital by the same general surgeon team. The cases were two young men who were admitted to the hospital from prison in the last three years. Both of them sustained stab heart wound. They were hemodynamically unstable. The first one suffered a cardiac arrest after his arrival in the operating room. Both patients underwent an emergency left anterolateral thoracotomy according to the DSTC course principles and the current guidelines of Trauma Surgery. The first patient had a left ventricle wound and a lung laceration and the second a wound on the right ventricle. Both patients underwent definite surgical repair. They were referred hemodynamically and respiratorily stable to a cardiothoracic ICU in Athens. They were discharged with no postoperative complications a few days after the initial operation

Anal vein thrombosis—excise or nothing

Purpose. The recurrence rates of excision, incision, and conservative treatments following anal vein thrombosis (AVT) are unclear. We compared the efficacy of treatment methods using Kaplan–Meier statistics. Our null hypothesis H0 is that incision of AVT gives as good results as surgical excision in terms of recurrence-free outcome. Methods. One hundred fifty patients treated in a single hospital in northern Germany from 2013 to 2017 were interviewed and their data analysed. Results. While recurrence-free outcome was about 22% following conservative treatment and 21% for incisional treatment, only surgical excision enabled recurrencefree outcome (86%) 4 years following surgery. While conservative and incisional therapy did not differ statistically, excision was significantly better than both of those treatments (p< 0.001). Conclusions. Our null hypothesis H0 that incision of AVT gives as good results as surgical excision in terms of recurrence free outcome was rejected. Incision of AVT should be abandoned, as it is painful, useless, and associated with a high recurrence rate as a conservative treatment in four of five patients. Surgical excision is the only method that enables significant recurrence-free outcome and should be used as the treatment of choice. Keywords Anal vein thrombosis · Therapy · Surgical excision · Recurrence rate · Pain · Visual analogue scale (VAS) · Thrombosed external hemorrhoi