International journal of surgery
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Shock, regardless of etiology is characterized by decreased delivery of oxygen and nutrients to the tissues and our interventions are directed towards reversing the cellular ischemia and preventing its consequences. The treatment strategies that are most effective in achieving this goal obviously depend upon the different types of shock (hemorrhagic, septic, neurogenic and cardiogenic). This brief review focuses on the two leading etiologies of shock in the surgical patients: bleeding and sepsis, and addresses a number of new developments that have profoundly altered the treatment paradigms. The emphasis here is on new research that has dramatically altered our treatment strategies rather than the basic pathophysiology of shock.
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Review
Preoperative assessment of cardiac risk and perioperative cardiac management in noncardiac surgery.
More than 27 million Americans undergo noncardiac surgery annually. Cardiac complications can be a major source of morbidity and mortality in the perioperative period. ⋯ In this review we briefly describe the current evidence on perioperative management of patients presenting for noncardiac surgery. As the surgeon will remain one of the first to evaluate patients before noncardiac surgery it is essential he/she be well versed with this information.
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Wrong-site surgeries (including wrong-site, wrong-person and wrong-procedure errors) remain the number one problem among adverse events of health care delivery. Patients and/or family members should be involved when possible to help prevent such errors. ⋯ The majority of participants reported good practices for avoiding wrong-site surgery mistakes before an operation. A significant improvement of post-training scores in the family member group was seen. The high satisfaction rating given by the participants after seeing the animation indicates that it was generally acceptable.
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The root exit zone (REZ) of the seventh cranial nerve has been the target of microvascular decompression surgery (MVD) while searching the neurovascular conflict for treatment of hemifacial spasm for long time. Recently, increasing cases regarding the offending vessel beyond the REZ have been reported. To verify whether a thorough dissection of the nerve may give rise to a better postoperative result without enhancing complications, we conducted a parallel investigation. ⋯ These findings suggested that the entire-root-decompression technique is recommended while performing MVDs in patients with hemifacial spasm.
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Randomized Controlled Trial Comparative Study
A prospective single center study to assess the impact of surgical stabilization in patients with rib fracture.
To compare the intensity of pain and duration of return to normal activity in patients with rib fractures treated with surgical stabilization with plating versus conventional treatment modalities. ⋯ Surgical stabilization of rib fracture, an underutilized intervention is better than conventional conservative management in terms of both, decrease in intensity of pain and early return to normal activity.