International journal of surgery
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Randomized Controlled Trial
The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery: a randomised controlled study.
The aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery. ⋯ Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and leads to reduced consumption of tramadol postoperatively in patients undergoing major abdominal operations.
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Review
Damage control surgery in the abdomen: an approach for the management of severe injured patients.
Damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. In these patients the 'lethal triad' of hypothermia, acidosis, and coagulopathy is presented as a vicious cycle that often can not be interrupted and which marks the limit of the patient's ability to cope with the physiological consequences of injury. ⋯ There are five critical decision-making stages of damage control: I, patient selection and decision to perform damage control; II, operation and intraoperative reassessment of laparotomy; III, resuscitation in the intensive care unit; IV, definitive procedures after returning to the operating room; and V, abdominal wall reconstruction. The purpose of this article is to review the physiology of the components of the 'lethal triad', the indication and principles of abdominal damage control of trauma patients, the reoperation time, and the pathophysiology of abdominal compartment syndrome.
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Randomized Controlled Trial
Effect of intraoperative fluid optimisation on renal function in patients undergoing emergency abdominal surgery: a randomised controlled pilot study (ISRCTN 11799696).
Emergency abdominal surgery carries a high risk of postoperative morbidity and mortality. Goal directed therapy has been advocated to improve outcome in high-risk surgery. The aim of the present pilot study was to examine the effect of goal directed therapy using fluid alone on postoperative renal function and organ failure score in patients undergoing emergency abdominal surgery. ⋯ In the present pilot study replacing the identified fluid deficit was not associated with a change in renal function. These results do not preclude that goal directed therapy using fluid alone may have an effect on renal function but they would suggest that the effect size of fluid optimisation alone on renal function is small.
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The selection of patients who will undergo sentinel lymph node biopsy is primarily based on the histopathologic features of cutaneous melanoma. The purpose of this study is to identify prognostic factors that predict the sentinel lymph node metastasis in melanoma. ⋯ Patients with Breslow thickness >or=1.19 mm, ulceration, and lymphovascular invasion are at higher risk for occult lymph node metastases. In addition it is important to use multiple selection criteria when performing sentinel lymph node biopsy especially in patients with thin melanomas.