Management of hepatic injury.

Liver injuries may be due to either blunt or penetrating trauma to the thorax or abdomen. Specific treatment depends on the site and extent of hepatic injury. Following resuscitation with intravenous fluids and blood as needed, surgical therapy is directed to provide hemostasis, remove necrotic liver tissue and promote adequate external drainage in the postoperative period. While local measures are usually sufficient, complex hepatic wounds may require extensive resection and vascular ligature or repair.     

奥曲肽联合卡托普利治疗肝硬化难治性腹水疗效观察

目的:研究奥曲肽联合卡托普利治疗肝硬化难治性腹水的疗效.方法:59例肝硬化难治性腹水患者被随机分为两组,治疗组(29例)在常规治疗药物治疗上的加奥曲肽及卡托普利,对照组(30例)在常规治疗药物治疗上的加卡托普利,观察患者治疗后的腹围、血清尿素氮、肌酐和白蛋白、疗效.结果:治疗组总有效率82.7%(24/29)高于对照组60.%(18/30)(P＜0.01),腹围低于对照组(P＜0.05),治疗后两组血生化及肾功能指标间差异无统计学意义(P＞0.05).结论:奥曲肽联合卡托普利治疗肝硬化难活性腹水有较好的疗效和安全性.     

Laparoscopic diagnosis of ascites in Lesotho.

In a prospective study of 98 consecutive patients with undiagnosed ascites examined by laparoscopy a correct immediate diagnosis was made in 76 (78%) and a final diagnosis in 92 (94%) of those who underwent laparoscopy. Visual diagnosis was highly accurate in patients with tuberculous peritonitis but only moderately accurate in those with carcinomatosis and liver disease. When the laparoscopic findings were compared with histological and microbiological results visual diagnosis was found to be the most accurate diagnostic method. Laparoscopy may readily be used in rural hospitals for diagnosing ascites.     

Prune belly syndrome and fetal ascites.

A case of prune belly syndrome (PBS) in a 22 week male fetus is described. All the features characteristic of the syndrome were present: absence of abdominal muscle; dilatation of the bladder, ureters, and renal pelves; and undescended testes. In addition, there was marked ascites. The rectus abdominis muscles were entirely absent whereas other abdominal muscles were only absent centrally. Between regions of normal and absent musculature muscle fibers were sparse, enlarged, frequently disrupted, and mostly in the myotubule stage. The prostate was thin-walled and its urethra greatly expanded. The testes lay close to the corresponding ureters and each ductus deferens was only partially present. It is considered that prostatic dysgenesis and fetal ascites are key factors in the causation of PBS.