International journal of surgery
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The safety of the patient and its importance in a surgical setting is well recognised. However, in the literature far less emphasis is placed upon the safety of the surgeon and his/her team. This review discusses the risks to which a surgeon is exposed, including blood-borne pathogens, radiation exposure, biomechanical stresses and fatigue, and the adverse effects of diathermy fumes. Strategies addressing these risks are presented and recommendations to improve surgical team safety are offered.
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An overview of intra-abdominal sepsis is necessary at this time with new experimental studies, scoring systems and audits on management outcomes. The understanding of the pathophysiology of the peritoneum in the manifestation of surgical sepsis and the knowledge of the source of pathogenic organisms which reach the peritoneal cavity are crucial in the prevention of intra-abdominal infection. Inter-individual variation in the pattern of mediator release and of end-organ responsiveness may play a significant role in determining the initial physiological response to major sepsis and this in turn may be a key determinant of outcome. The ability to identify the presence of peritoneal inflammation probably has the greatest influence on the final surgical decision. The prevention of the progression of sepsis is by early goal-directed therapy and source control. Recent advances in interventional techniques for peritonitis have significantly reduced the morbidity and mortality of physiologically severe complicated abdominal infection. In the critically ill patients there is some evidence that the prevention of gut mucosal acidosis improves outcome. The aim of this review is to ascertain why intra-abdominal sepsis remains a major clinical challenge and how a better understanding of the pathophysiology may enable its prevention and better management. ⋯ Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on intra-abdominal sepsis and the current management. Relevant articles were searched from relevant chapters in specialized texts and all included.
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Blood loss during resection of the hepatic parenchyma in hepatectomy can be minimized using vessel-sealing (VS) devices. Some sealing devices were retrospectively compared to evaluate the efficacy of each device for controlling blood loss, transection time and postoperative complications in hepatectomy as a cohort study. ⋯ The use of energy sealing devices improves surgical results and avoids hepatectomy-related complications. Adequate use of vessel sealers is necessary for safe and rapid completion of hepatic resection.
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According to characteristic of anatomical structure of calcaneus and sinus tarsi approach, the minimally invasive plate for treatment of displaced intra-articular calcaneal fractures had been designed. Here we aimed to review the effect of this treatment. Forty intra-articular calcaneal fractures in 38 patients from September 2006 to September 2008 were treated with percutaneous plate via sinus tarsi approach under the monitoring of C-shaped arms. ⋯ Maryland foot score demonstrated that excellent result was achieved in 32 cases, good in 6 cases, fair in 2 cases, and the excellent and good rate was 95%. Postoperative complications were not found in all fractured feet. Our results suggest that this minimally invasive sinus tarsi approach with new designed plate and screw fixation technique for the treatment of intra-articular calcaneal fractures can not only obtain the satisfactory outcomes, but also can effectively prevent surgical complications.
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Every investigation that can contribute towards a diagnosis of appendicitis is valuable to the emergency general surgeon. Previous research has suggested that hyperbilirubinaemia is a more specific marker for both simple and perforated appendicitis than WBC (white blood count) and CRP (C-reactive protein), but this investigation is not commonly used to help diagnose appendicitis. ⋯ Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis, especially when perforated, from other causes of RIF pain, particularly those not requiring surgery.