World journal of surgery
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World journal of surgery · Mar 2009
Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.
Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. ⋯ Conservative treatment methods have little or no effect on extensive perineal/perianal hidradenitis suppurativa. Therefore, total surgical excision must be considered for these patients to prevent further complications, such as abscess, sinus tract formation, fistulization, and scarring. A temporary stoma may be needed in some cases. Because wound management after total excision is performed via different methods according to each individual patient, multidisciplinary team work is necessary and the patients often require a long hospital stay. If the treatment is not performed in an appropriate manner or if the patients are not followed closely until definitive healing, recurrence is almost inevitable. Despite the low incidence of accompanying squamous cell carcinoma, it is the most serious complication. We evaluated 15 patients to present our experience with extensive perineal/perianal and gluteal hidradenitis suppurativa.
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World journal of surgery · Mar 2009
Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients.
Elevated lactate and interleukin-6 (IL-6) levels were shown to correlate with mortality and multiple organ dysfunction in severely traumatized patients. The purpose of this study was to test whether an association exists between 24-hour lactate clearance, IL-6 and procalcitonin (PCT) levels, and the development of infectious complications in trauma patients. ⋯ This study demonstrates that elevated early procalcitonin and IL-6 levels and inadequate 24-hour lactate clearance help identify trauma patients who develop septic and nonseptic infectious complications. Definition of specific cutoff values and early monitoring of these parameters may help direct early surgical and antibiotic therapy and reduce infectious mortality.
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World journal of surgery · Mar 2009
Pain management for unilateral orchidopexy in children: an effective regimen.
The reported high incidence of 30-60% postoperative pain after an elective day surgical orchidopexy is undesirable. We evaluated the efficacy of our analgesic regimen for unilateral orchidopexy in preschool children performed as a day surgical procedure. ⋯ Clinical effectiveness of our institution analgesic regime justifies the performance of unilateral orchidopexy as a day-case procedure.
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World journal of surgery · Feb 2009
Evisceration following abdominal stab wounds: analysis of 66 cases.
Abdominal stab wounds with evisceration remain an indication for emergency laparotomy. The purpose of this study was validate a policy of mandatory laparotomy for organ evisceration and a policy of selective nonoperative management with serial physical abdominal examination for omentum evisceration. ⋯ Evisceration should continue to prompt operative intervention. An exception can be made to a select few patients with omentum evisceration with benign abdominal findings.
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World journal of surgery · Feb 2009
Randomized Controlled TrialPilot postoperative ileus study of escin in cancer patients after colorectal surgery.
Postoperative ileus, a common complication in patients after abdominal surgery, brings no benefit to the recovery of postoperative patients, and treatment targeted at restoring gastrointestinal motility may shorten the hospital stay. Studies have shown that escin accelerates gastrointestinal transit in mice and improves gastrointestinal motility in patients after abdominal surgery. A pilot study of escin's effect on the recovery of gastrointestinal motility was conducted in colorectal cancer patients in anticipation of a multiple-center randomized controlled trial. ⋯ The results of this pilot Postoperative Ileus Study of Escin (PISE) showed that escin can shorten the time to recovery of gastrointestinal motility in cancer patients after colorectal surgery.