European surgical research. Europäische chirurgische Forschung. Recherches chirurgicales européennes
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In the event of a spatial or temporal microvascular perfusion heterogeneity conventional methods are often inadequate to describe the microcirculatory changes. Our aim was to use a new formula to characterize and compare the microcirculatory reactions in the mucosa and longitudinal muscle of the rat small intestine in response to hypertonic/hyperoncotic and normotonic resuscitation strategies. ⋯ The hypertonic/hyperoncotic solution induces a considerable microcirculatory improvement in two distinct layers of the small intestine after HS. This positive effect is related to the amelioration of the intestinal microcirculatory heterogeneity.
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Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. ⋯ At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.
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Comparative Study
Does mesh implantation affect the spermatic cord structures after inguinal hernia surgery? An experimental study in rats.
Inguinal hernia repair is the most common operation in general surgery. Prosthetic reinforcement of the inguinal area with polypropylene mesh has increased dramatically in the last decade. The aim of this study was to evaluate how different types of mesh affect the spermatic cord structures. ⋯ In conclusion, the only effect on the spermatic cord structures in a rat model is seen as an impaired s-testosterone production and a reduced cross-sectional area of the vas deferens after use of a low-weight composite mesh compared to the control side. No difference in inflammation or fibrosis was found between heavyweight polypropylene mesh and low-weight composite mesh.
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Aortic occlusion has been suggested for the initial treatment of severe uncontrolled hemorrhagic shock. Our objective is to determine the impact of aortic occlusion, during hemorrhagic shock, on splanchnic mucosal perfusion and to correlate these findings with other systemic and regional markers of splanchnic ischemia. ⋯ Aortic occlusion promotes blood pressure restoration with an additional insult to mucosal perfusion, which could be adequately predicted by global and/or splanchnic oxygen-derived variables during ischemia, but not during the early reperfusion period.
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Institutions with quality management programs need to evaluate the quality of perioperative pain management as well as other aspects of the health service. With the development of anesthesia-based pain services, improvement in this field has been reported. In this prospective study performed in a university hospital, we used a Postoperative Pain Therapy Assessment Questionnaire to quantify the effectiveness of pain therapy and factors affecting the degree of satisfaction and also to pinpoint areas that need improvement. ⋯ By analyzing the questionnaires, we found that patients were satisfied with the pain therapy performed under the guidance of anesthesiologists, but predictors of satisfaction such as pain intensity and side effects (nausea, vomiting, constipation and difficulty in walking) decreased patient satisfaction considerably. Patients are aware of the fact that health care givers take postoperative care seriously and they do not want any untoward effects interrupting their postoperative care. They are trying to participate in the decision making and also to learn more about pain medicine.