Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jan 2010
Obesity and recovery from low back pain: a prospective study to investigate the effect of body mass index on recovery from low back pain.
We describe a prospective cohort study to investigate any association between recovery from low back pain and body mass index (BMI) in patients with low back pain undergoing physiotherapy. ⋯ This study demonstrates that BMI does not influence the overall recovery from low back pain in patients undergoing physiotherapy treatment.
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Ann R Coll Surg Engl · Nov 2009
Case Reports'Not just another appendicitis!' - a case report of acute abdominal pain caused by splenic rupture secondary to isolated splenic peliosis.
We present the case of a 31-year-old man admitted with acute abdominal pain who was subsequently found to have a ruptured spleen. A splenectomy was performed as an emergency and he was discharged from hospital 4 days later. Histological analysis revealed isolated splenic peliosis as the underlying condition predisposing to his splenic rupture.
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There is wide variation in costs, both theatre and ward, for the same operation performed in different hospitals. The aim of this study was to compare the true costs for a large number of consecutive laparoscopic cholecystectomy (LC) cases using re-usable equipment with those from an adjacent trust in which the policy was to use disposable LC equipment. ⋯ This study has demonstrated that considerable savings occur with a policy of minimal use of disposable equipment for LC. Using a disposable set, the instrument costs per procedure is 6.4 times greater than the cost of using re-usable LC sets. It behoves surgeons to be cost-effective and to reduce unnecessary expenditure and wastage. There is no evidence to support use of once-only laparoscopic instruments on grounds of patient safety, ease of use or transmission of infection. If the savings identified in this study of two surgeons' work (savings of pound484,861.84 in a 7-year period) was extended not only across the hospital but across the NHS, large savings could be made for laparoscopic cholecystectomy. Even greater savings would accrue if the results were extrapolated to cover all laparoscopic surgery of whatever discipline.
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Ann R Coll Surg Engl · Nov 2009
Low plasma albumin linked to fluid overload in postoperative epidural patients.
Hypotension is commonly associated with epidural use in postoperative patients and is usually treated with fluid or vasopressor therapy. The former can result in fluid overload, associated with significant morbidity. This study aimed to identify factors increasing the likelihood of fluid overload in elective patients. ⋯ Patients receiving epidurals with initial, postoperative, plasma albumin levels below 27 g/l are at increased risk of significant fluid overload. Earlier instigation of vasopressor therapy in this subgroup of patients may help prevent this.
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Ann R Coll Surg Engl · Oct 2009
Case ReportsPenetrating missile injuries during the Iraqi insurgency.
Since the invasion of Iraq in 2003, the conflict has evolved from asymmetric warfare to a counter-insurgency operation. This study investigates the pattern of wounding and types of injuries seen in casualties of hostile action presenting to a British military field hospital during the present conflict. ⋯ The current insurgency in Iraq illustrates the likely evolution of modern, low-intensity, urban conflict. Improvised explosive devices employed against both military and civilian targets have become a major cause of injury. With the current global threat from terrorist bombings, both military and civilian surgeons should be aware of the spectrum and emergent management of the injuries caused by these weapons.