World journal of surgery
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World journal of surgery · Aug 2011
Swan-Ganz catheter use in trauma patients can be reduced without negatively affecting outcomes.
The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome. ⋯ The use of PAC has decreased almost 10-fold over the last decade at our institution. The PAC is being used later during the ICU course and for a shorter period of time. In a matched population, the use of PAC is associated with a significantly higher mortality and complication rate, but the reason for this association remains uncertain. The use of PAC is invasive and is associated with known complications and financial costs. While the use of PAC maybe useful in a select population, routine and widespread use of the PAC should be avoided.
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World journal of surgery · Aug 2011
Rwandan surgical and anesthesia infrastructure: a survey of district hospitals.
In low-income countries, unmet surgical needs lead to a high incidence of death. Information on the incidence and safety of current surgical care in low-income countries is limited by the paucity of data in the literature. The aim of this survey was to assess the surgical and anesthesia infrastructure in Rwanda as part of a larger study examining surgical and anesthesia capacity in low-income African countries. ⋯ This survey provides strong evidence of the need for continued development of emergency and essential surgical services at district hospitals in Rwanda to improve health care and to comply with World Health Organization recommendations. It has identified serious deficiencies in both financial and human resources-areas where the international community can play a role.
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World journal of surgery · Aug 2011
Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution.
Chronic pilonidal disease is a debilitating condition that typically affects young adults. There is a wide variety of available therapeutic strategies reflecting the inconsistent outcomes attributed to the various operative approaches. The majority involve excision of the sinus tract followed by either primary closure or healing by secondary intention. A variety of closure approaches exist. There remains uncertainty as to which is more effective. The aim of the current study was to determine subjective and objective outcomes following excision and Karydakis flap closure in a unit where this technique is the standard of care in the management of chronic pilonidal disease. ⋯ Excision and primary closure with Karydakis flap is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to premorbid functioning, and a high degree of patient satisfaction (92%).
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World journal of surgery · Jul 2011
Clinical TrialDoes prophylactic biologic mesh placement protect against the development of incisional hernia in high-risk patients?
The purpose of this study was to determine whether the prophylactic use of a biologic prosthesis protects against the development of incisional hernia in a high-risk patient population. ⋯ The prophylactic use of biologic mesh for abdominal wall closure appears to reduce the incidence of incisional hernia in patients with multiple risk factors for incisional hernia development.
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World journal of surgery · Jul 2011
Randomized Controlled Trial Comparative StudyCelsior versus University of Wisconsin preserving solutions for liver transplantation: postreperfusion syndrome and outcome of a 5-year prospective randomized controlled study.
Celsior solution (CS) is a high-sodium, low-potassium, low-viscosity extracellular solution that has been used for liver graft preservation in recent years, although experience with it is still limited. We performed an open-label randomized active-controlled trial comparing CS with the University of Wisconsin solution (UW) for liver transplantation (LT), with a follow-up period of 5 years. ⋯ While retaining the same degree of safety and effectiveness as UW for LT, CS may yield postliver graft reperfusion benefits, as shown in this study by a significant reduction in the incidence of PRS and greater metabolic control.