World journal of surgery
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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.
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World journal of surgery · Sep 2009
Combined lumbar spinal and thoracic high-epidural regional anesthesia as an alternative to general anesthesia for high-risk patients undergoing gastrointestinal and colorectal surgery.
A prospective study was undertaken to review the use of combined lumbar spinal and thoracic high-epidural regional anesthesia in high-risk patients who underwent gastrointestinal/colorectal surgery from 2004 to 2006. ⋯ This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery--particularly for the management of high-risk patients presenting in the emergency setting.
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World journal of surgery · Sep 2009
Use of a trauma service clinical pathway to improve patient outcomes for retained traumatic hemothorax.
Early evacuation of retained hemothorax (RHTX) has been shown to improve clinical outcomes. In 2006, our trauma surgery service instituted a clinical pathway for management of RHTX that was designed to decrease time to operation and improve patient outcomes. We report our experience with early evacuation of posttraumatic RHTX after instituting a service-wide clinical pathway. ⋯ Implementation of a clinical pathway for early evacuation of retained hemothorax can significantly improve patient outcomes and decrease hospital costs. Furthermore, trauma surgeons are capable of safely performing thoracic surgery for evacuation of retained hemothorax.
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World journal of surgery · Aug 2009
Value of MELD and MELD-based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases.
Recent studies have suggested that the Model for End-Stage Liver Disease (MELD) may represent a promising alternative to the Child-Turcotte-Pugh classification as a predictive factor of operative mortality and morbidity. This study was designed to evaluate the value of MELD and four MELD-based indices (iMELD: integrated MELD; MESO: MELD to sodium ratio; MELD-Na: MELD with incorporation of sodium; MELD-XI: MELD excluding the International Normalized Ratio) in the quantification of surgical risk for patients with cirrhosis and compare its prognostic value with the Child-Turcotte-Pugh classification and two derived scores (proposed by Huo and Giannini, respectively). ⋯ In this study, iMELD was a useful predictive parameter of operative mortality for patients with cirrhosis submitted to elective procedures. Further studies are necessary to define the relevance of MELD-based indices in the individual surgical risk evaluation.