International journal of surgery
-
The abdomen is routinely considered as a possible source of bleeding in hypotensive and unevaluable blunt multitrauma patients. These patients are often unstable to be transported for abdominal computed tomography (CT). Emerging data on Focused Assessment with Sonography for Trauma (FAST) exam questions its initially reported high accuracy. We hypothesized that Diagnostic Peritoneal Aspiration (DPA), without a full lavage, accurately detects intraperitoneal blood if present in sufficient volume to cause hypotension and warrant emergent operation. ⋯ Percutaneous DPA is accurate, rapid, safe, and superior to FAST for the diagnosis of abdominal blood as the source of hemodynamic instability, requiring emergent surgery, in blunt multitrauma patients.
-
Recent studies have emphasised the importance of optimisation of intraoperative fluid administration in patients undergoing major abdominal surgery. A variety of non-invasive devices capable of measuring cardiac output are available for this purpose. Most studies have used the Deltex CardioQ Oesophageal Doppler monitor (DCQ ODM, Deltex, Chichester, Sussex, UK). A relatively new, totally non-invasive cardiac monitor is now available, the Novametrix-Respironics NICO machine (Novametrix-Respironics, USA). ⋯ Caution should be exercised before using these monitors to optimise intraoperative fluid administration as potentially very large volumes of fluid may be administered to achieve surrogate endpoints. These devices need to be compared side by side with a gold standard method of determining cardiac output before they can be used interchangeably for optimising intraoperative fluid administration in abdominal surgery.
-
This paper reports the results of a questionnaire-based survey of pancreatic surgical specialists in the United Kingdom addressing aspects of staging, resection volume and outcome. A postal survey was undertaken of the 517 members of the Association of upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). 57 surgeons undertook pancreatic resection from 162 overall respondents. Cross-checking with the list of members of the Pancreatic Society of Great Britain and Ireland yielded 64 pancreatic surgeons. 734 pancreaticoduodenectomy (PD) were reported by respondents compared with 822 procedures according to Government maintained Hospital Episode Statistics. ⋯ All clinicians with mortality rates in excess of 10% did less than 10 resections per annum. Respondents favoured "amylase rich discharge beyond 7th post-operative day" as optimal for definition of post-resection pancreatic fistula. Accepting the limitations of questionnaire surveys, the results provide an important overview of pancreatic surgical practice: pancreaticoduodenectomy is carried out by a range of specialists, lower volume resectionists appear to have poorer outcomes and this study shows widespread agreement on optimum terminology for post-operative pancreatic fistula.