World journal of surgery
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World journal of surgery · Apr 2006
Comparative StudyOutcomes of surgery for mid and distal rectal cancer in the elderly.
This study aimed to evaluate the surgical strategies, operative results, and oncological outcomes of elderly patients who underwent curative resection for mid and distal rectal cancer. Comparison was made with patients of younger age. ⋯ Curative resection for mid and distal rectal cancer for the elderly can be performed safely with the same strategies of sphincter preservation used for younger patients. The postoperative complications and the 5-year cancer-specific survival rates were similar to those of younger patients.
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World journal of surgery · Apr 2006
Case ReportsSequential preoperative ipsilateral portal and arterial embolization in patients with colorectal liver metastases.
Preoperative portal vein embolization (PVE) induces ipsilateral atrophy of the hepatic parenchyma to be resected, as well as contralateral compensatory hypertrophy of the residual liver. However, there are two potential problems with this technique: inadequate contralateral hypertrophy and tumor progression while waiting for the non-embolized liver to hypertrophy. We devised a strategy to deal with these two problems by performing an ipsilateral hepatic artery embolization 6 weeks after an unsatisfactory PVE in an effort to accelerate the hypertrophy of the remnant liver. ⋯ In our experience sequential ipsilateral portal vein and hepatic artery embolization extended the indications for liver resection for metastatic colorectal cancer.
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World journal of surgery · Apr 2006
Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery.
Anesthesia adversely affects respiratory function and hemodynamics in obese patients. Although many studies have been performed in morbidly obese patients, data are limited concerning overweight patients [BMI 25-29.9 kg m(-2)]. The aim of this study was to evaluate the effects of prolonged pneumoperitoneum in Trendelenburg position on hemodynamics and gas exchange in normal and overweight patients. ⋯ Arterial oxygenation and A(a)DO2 are significantly impaired in overweight patients under general anesthesia in Trendelenburg posture. In overweight patients pneumoperitoneum transient reduced the impairment of arterial oxygenation and lead to a decrease in A(a)DO2. Hemodynamic parameters were not affected by body weight.
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World journal of surgery · Apr 2006
Civilian duodenal gunshot wounds: surgical management made simpler.
Low-velocity gunshot wounds cause most civilian duodenal injuries. The objective of this study was to describe a simplified surgical algorithm currently in use in a South African civilian trauma center and to verify its validity by measuring morbidity and mortality. ⋯ Most civilian low-velocity duodenal gunshot injuries treated with simple primary repair result in overall morbidity, mortality, and duodenum-related complication rates comparable to those in reports where more complex surgical procedures were employed. Primary repair is also applicable for most combined pancreatic and duodenal gunshot injuries.