World journal of surgery
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World journal of surgery · Jan 2009
Rib fracture repair: indications, technical issues, and future directions.
Rib fracture repair has been performed at selected centers around the world for more than 50 years; however, the operative indications have not been established and are considered controversial. The outcome of a strictly nonoperative approach may not be optimal. ⋯ Nonetheless, several effective repair systems have been developed. Future directions for progress on this important surgical problem include the development of minimally invasive techniques and the conduct of multicenter, randomized trials.
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A number of recent studies have demonstrated disparity between racial groups in both outcome and processes of trauma care. These were not controlled for the presence of shock. ⋯ We found no mortality differences based on race for GSW. Hispanics have a higher mortality rate for MVC. For both injury types, Blacks and Hispanics had shorter hospital stays and a greater likelihood of transfer to post-acute care when compared to white patients. Hypotension on admission has a much more significant impact on outcome than race and ethnicity.
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World journal of surgery · Dec 2008
ReviewBreast cancer issues in developing countries: an overview of the Breast Health Global Initiative.
Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided. ⋯ The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.
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Selective nonoperative management (SNOM) of penetrating neck injuries (PNI) has steadily gained favor, but indications for surgery and adjunctive diagnostic studies remain debated. The purpose of the present study is to validate a protocol of SNOM of PNI based on physical examination, which further dictates complementary investigations and management. ⋯ Selective nonoperative management of neck injuries based on clinical examination and selective use of adjunctive investigational studies is safe in a high-volume trauma center.
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World journal of surgery · Dec 2008
Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy.
Retrospective studies concerning the operative preservation and nonoperative management of splenic injuries in patients with splenic trauma have been published; however, few studies have analyzed prospectively the results and early complication rates of a defined management in splenic injury. ⋯ Splenic preservation in patients with blunt splenic injury by operative or nonoperative treatment leads to lower early infection rates in adults and, therefore, should be advocated.