World journal of surgery
-
World journal of surgery · Feb 2010
Performance of a computerized protocol for trauma shock resuscitation.
A computerized protocol was developed and used to standardize bedside clinician decision making for resuscitation of shock due to severe trauma during the first day in the intensive care unit (ICU) at a metropolitan Level I trauma center. We report overall performance of a computerized protocol for resuscitation of shock due to severe trauma, incorporating two options for resuscitation monitoring and intervention intensity, according to: (1) duration of use and (2) acceptance of computerized protocol-generated instructions. ⋯ A computerized protocol to guide decision making for trauma shock resuscitation in a Level 1 trauma center surgical ICU was developed and used as standard of care. During 2 years ending at August 2006, 94% of computer-generated instructions for specific interventions or measurements of hemodynamic performance were accepted by bedside clinicians, indicating appropriate, useful design and reliance on the computerized protocol system.
-
World journal of surgery · Feb 2010
Development and evaluation of an observational tool for assessing surgical flow disruptions and their impact on surgical performance.
Many researchers have previously explored the correlation between surgical flow disruptions and adverse events in cardiac surgery; however, there is no reliable tool to prospectively categorize surgical flow disruptions and the conditions that predispose a surgical team to adverse events. ⋯ This research depicts the development and utility of a tool to analyze surgical flow disruptions in the cardiovascular operating room with satisfactory inter-rater reliability. This tool is an important first step in systematically categorizing and measuring surgical flow disruptions and their impact on patient safety in the operating room.
-
World journal of surgery · Feb 2010
Pain as the only consistent sign of acute appendicitis: lack of inflammatory signs does not exclude the diagnosis.
The clinical diagnosis of acute appendicitis in adults remains tricky, but radiological examinations are very helpful to determine the diagnosis even when the adult patient presents atypically. This study was designed to quantify the proportion of patients with a preoperative diagnosis of acute appendicitis that had isolated right lower quadrant pain without biological inflammatory signs and then to determine which imaging examination led to the determination of the diagnosis. ⋯ The diagnosis of acute appendicitis cannot be excluded when an adult patient presents with isolated rebound tenderness in the right lower quadrant even without fever and biological inflammatory signs. In our study, ultrasonography and computed tomography were very helpful when making the final diagnosis.
-
World journal of surgery · Feb 2010
Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy.
Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. ⋯ This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.
-
World journal of surgery · Jan 2010
Unroofing and curettage for the treatment of acute and chronic pilonidal disease.
Various surgical techniques are available in the management of pilonidal sinus, but controversy concerning the optimal surgical approach persists. The present study analyzes the outcome of unroofing and curettage as the primary intervention for acute and chronic pilonidal disease. ⋯ Unroofing and curettage for pilonidal sinus disease is an easy and effective technique. The vast majority of the patients, including those with abscess as well as those with chronic disease, will heal with this simple procedure, after which even recurrences can be managed successfully with the same procedure. Relying on these results, we advocate unroofing and curettage as the procedure of choice in the management of pilonidal disease.