World journal of surgery
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The Essential Trauma Care (EsTC) Project represents an effort to set reasonable, affordable, minimum standards for trauma services worldwide and to define the resources necessary to actually provide these services to every injured person, even in the lowest-income countries. An emphasis is improved organization and planning, at minimal cost. The EsTC Project is a collaborative effort of the World Health Organization and the International Association for Trauma Surgery and Intensive Care, an integrated society within the International Society of Surgery-Société Internationale de Chirurgie. ⋯ It has stimulated five national-level consultation meetings on trauma care, which constituted the highest governmental attention yet devoted to trauma care in those countries. At these meetings, the EsTC resource templates were adjusted to local circumstances and implementation strategies developed. Future efforts need to emphasize more on-the-ground implementation in individual countries, greater linkages with prehospital care, and wider political endorsement, such as by passage of a World Health Assembly resolution.
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World journal of surgery · Jun 2006
Advancing Essential Trauma Care through the partner organizations: IATSIC, ISS-SIC, and WHO.
The publication Guidelines for Essential Trauma Care offers an opportunity to improve trauma care services in an affordable and sustainable fashion, primarily through improved organization and planning. The publication will be useful, however, only if it actually catalyzes improvements in trauma care in health care facilities in individual countries, especially those low- and middle-income countries with the greatest needs. ⋯ This includes such activities as organizing multi-sectoral stakeholders' meetings to adapt the Essential Trauma Care (EsTC) criteria to local needs; conducting trauma care needs assessments to identify priorities for low-cost improvements; having surgical colleges and societies throughout the world endorse the Guidelines; lobbying ministries of health to incorporate the EsTC recommendations into health policy; and seeking to integrate the EsTC recommendations into the 2-year action plans of WHO country offices. In all of these activities, surgeons and others who care for the injured can play a pivotal role, especially working collaboratively with their own ministries of health and WHO country offices.
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World journal of surgery · Jun 2006
One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV).
Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann's procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann's procedure only for Hinchey stage IV diverticulitis. We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage colon resection and primary anastomosis without protective colostomy. ⋯ One-stage sigmoid resection and primary anastomosis can be performed safely in nearly 90% of all patients with perforated sigmoid diverticulitis (Hinchey III/IV) by surgeons of different training levels. Patients with immunosuppression, chronic renal failure, liver cirrhosis, or previous organ transplantation or complex cardiovascular reconstructive procedures have a significantly increased risk of dying after sigmoid resection for perforated diverticulitis.
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The purpose of this study was to evaluate the feasibility of primary inguinal repair with open tension-free and sutureless technique using a new polypropylene "patch and plug system" (Prolene 3D patch), and the quality of the treatment in terms of reduction of postoperative discomfort. ⋯ The new mesh seems to satisfy all requirements of a feasible, reliable, and effective device for repairing primary inguinal hernia with high patient comfort.
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World journal of surgery · Jun 2006
Indications and techniques of extended resection for pancreatic cancer.
The resectability rate and postoperative survival rate for pancreatic carcinoma are poor. Aggressive resection including vascular resection and extended lymphadenectomy represent one strategy for improving survival. This study was carried out to clarify the indications for extended resection, especially vascular resection, for pancreatic carcinoma. ⋯ The most important indication for vascular resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins. Otherwise, vascular resection is contraindicated. Extended lymphadenectomy may be not of benefit.