World journal of surgery
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World journal of surgery · Apr 2005
Comparative StudyDo intraoperative total serum and ionized calcium levels, like intraoperative intact PTH levels, correlate with cure of hyperparathyroidism?
Intraoperative parathyroid hormone (ioPTH) monitoring is useful in the operative management of hyperparathyroidism. Measurement of intraoperative total serum calcium (TSC) and ionized calcium (ICa) levels may be less expensive and more readily available methods of intraoperative guidance during neck dissection than ioPTH levels, the gold standard. We compared the accuracy of monitoring intraoperative TSC and ICa to that of ioPTH for predicting surgical cure during parathyroidectomy. ⋯ Decreases in TSC and ICa during parathyroidectomy, if present, are thus minimal. Unlike ioPTH levels, TSC and ICa levels do not consistently decrease at 5 and 10 minutes after gland resection. Although inexpensive and readily available, monitoring the intraoperative TSC and ICa is not clinically reliable for confirming removal of hyperfunctioning parathyroid glands.
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Optimal treatment of burn victims requires deep understanding of the profound pathophysiological changes occurring locally and systemically after injury. Accurate estimation of burn size and depth, as well as early resuscitation, is essential. ⋯ An ideal therapy would not only promote rapid healing but would also act as an antiscarring therapy. The present article is a literature review of the most up-to-date modalities applied to burn treatment without overlooking the numerous controversies that still persist.
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World journal of surgery · Feb 2005
Randomized Controlled Trial Clinical TrialAddition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence.
The incidence of fascial dehiscence and incisional hernia after two methods for abdominal wound closure (rectus sheath relaxation incisions and conventional mass closure) was studied in a randomized prospective clinical trial in a consecutive series of 100 patients undergoing midline laparotomy for peritonitis. The two groups were well matched for etiologies of peritonitis, the surgical procedures performed, and the presence of known risk factors for fascial dehiscence. Fifty patients each were randomized either to the conventional continuous mass closure procedure or the rectus sheath relaxation incision technique (designed to increase wound elasticity and decrease tension in the suture line) using identical polypropylene sutures. ⋯ The incidence of wound hematoma was significantly increased in the rectus sheath relaxation incision group. The incidences of fascial dehiscence (16% vs,28%; p < 0.05) and incisional hernia (18% vs, 30%; p < 0.05) were significantly lower after rectus sheath relaxation incisions compared to conventional mass closure. Closure of the midline laparotomy wound in cases of peritonitis using the rectus sheath relaxation technique is safe and less painful, provides increased wound elasticity and decreased tension on the suture line, and significantly decreases the incidence of wound dehiscence.
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World journal of surgery · Jan 2005
Experience of treating gunshot wounds of large vessels in Afghanistan.
The problem of treating injuries of large vessels in times of peace has been sufficiently well developed both in theoretical and practical aspects. In times of war, however, due to the large numbers of the wounded, a shortage of expert angiosurgeons, and multiple gunshot wounds, many theoretical tenets lose their academic regularity. The present study is based on the experience of treating 302 patients wounded during the Afghanistan war (1981-1985). ⋯ In 6.6% of the cases extremities were amputated during the early postoperative period as a result of vessel thrombosis and an increase of tissue ischemia. The mortality rate after vessel surgery was 5.3%. We believe that for patients with gunshot wounds involving vessel injuries, early one-time reconstruction of the destroyed anatomical structures should be performed.
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World journal of surgery · Jan 2005
ReviewCombat casualty care research: from bench to the battlefield.
Hemorrhagic shock is the leading cause of death in civilian and combat trauma. Effective hemorrhage control and better resuscitation strategies have the potential of saving lives. ⋯ This article highlights the salient achievements of this research effort in the areas of hemorrhage control, resuscitation, design and testing of devices, and some novel concepts such as the use of profound hypothermia. The impact of these basic science research findings on changes in military medical care and outcome of injured soldiers is also described.