World journal of surgery
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World journal of surgery · Sep 2009
Randomized Controlled TrialA randomized, clinical trial of frozen versus standard nasogastric tube placement.
Insertion of a nasogastric tube (NGT) in an anesthetized, paralyzed, and intubated patient is difficult, and many methods have been proposed to aid in the procedure. We present a simple insertion technique. ⋯ A simple method of freezing an NGT with distilled water increased the success rate of insertion for intubated patients.
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World journal of surgery · Sep 2009
Comparative StudyFactors related to preoperative assessment of the circumferential resection margin and the extent of mesorectal invasion by magnetic resonance imaging in rectal cancer: a prospective comparison study.
This study was designed to identify factors related to inaccurate prediction of circumferential resection margin (CRM) and the extent of mesorectal invasion (EMI) in T3 tumors by preoperative magnetic resonance imaging (MRI) in rectal cancer. ⋯ Preoperative chemoradiation can be accurately guided by preoperative MRI staging, but CRM and EMI in anterior rectal tumor should be interpreted with caution.
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World journal of surgery · Sep 2009
Controlled Clinical TrialStabilized infective endocarditis and altered heparin responsiveness during cardiopulmonary bypass.
Although active infective endocarditis (IE) is known as a risk factor for decreased heparin responsiveness during cardiopulmonary bypass (CPB), evidence is lacking in patients with stabilized IE. We investigated whether heparin responsiveness was still altered in stabilized IE patients undergoing cardiac surgery in a prospective, controlled trial. ⋯ Heparin responsiveness during CPB was significantly reduced in the IE group, and it seems to be associated with preoperative hypercoagulability and reduced antithrombin III activity. Therapeutic measures such as the administration of antithrombin III concentrate should be considered in these patients even when they are in a stabilized condition without active inflammation.
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World journal of surgery · Sep 2009
Randomized Controlled TrialAttenuation of the systemic inflammatory response and infectious complications after gastrectomy with preoperative oral arginine and omega-3 fatty acids supplemented immunonutrition.
Past trials have shown perioperative immunonutrition to improve the outcome for patients with gastric cancer. The present study was designed to evaluate the effect of preoperative oral immunonutrition on cellular immunity, the duration of the systemic inflammatory response syndrome (SIRS), and detailed postoperative complications in patients with gastric cancer. ⋯ Preoperative oral immune-enhanced formulas supplemented with arginine and omega-3 fatty acids enhanced the immune status of the patients, reduced the duration of SIRS, and decreased the incidence of postoperative infectious complications. CD4(+)T-cell immunity likely played an important role in the modulation of the postoperative immune and inflammatory response after gastrectomy.
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World journal of surgery · Sep 2009
A change in practice from epidural to intrathecal morphine analgesia for hepato-pancreato-biliary surgery.
This study was designed to audit the change of anesthetic practice from thoracic epidural analgesia (TEA) to intrathecal morphine (ITM) combined with patient-controlled analgesia (PCA) for hepato-pancreato-biliary (HPB) surgery. ⋯ In a resource-limited setting, ITM, compared with TEA, is associated with a reduced incidence of postoperative hypotension, reduced IVF requirements, shorter hospital stay, and lowers the incidence of respiratory complication.