World journal of surgery
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World journal of surgery · Oct 2009
Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes.
Weight gain and obesity are driving the global epidemic of type-2 diabetes through metabolic and inflammatory pathways that cause insulin resistance and impair pancreatic beta-cell function, the two important factors that are directly responsible for the development of this disease in susceptible populations. Lifestyle methods and modest weight loss are powerful at preventing and managing type-2 diabetes, but sustaining substantial weight loss is problematic. Bariatric surgery provides exceptional sustained weight loss and remission of type-2 diabetes in 50-85% of subjects, especially if treated early before irreparable beta-cell damage has occurred. ⋯ A range of novel surgical, endoluminal procedures/devices, and pharmacologic therapies are likely to evolve when we better understand how bariatric surgery enables long-term changes in energy balance and non-weight-related metabolic improvements. Bariatric surgery should be considered for adults with BMI >or= 35 kg/m(2) and type-2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy. Although all bariatric procedures produce exceptional results in the management of type-2 diabetes, choice of procedure requires a careful risk-benefit analysis for the individual patient.
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World journal of surgery · Oct 2009
Development of a large animal model for investigating resuscitation after blast and hemorrhage.
Blast injuries are an increasing problem owing to the widespread terrorist threat, but hemorrhage remains the second leading cause of civilian trauma death. Against this background, increasing numbers of prehospital and military trauma organizations are advocating a hypotensive approach to resuscitation of the hypovolemic casualty, deliberately aiming not to achieve a normal blood pressure so as not to disturb any newly formed blood clots at the site of a vascular injury. ⋯ The preliminary results confirm the reliability and reproducibility of this model.
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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.