World journal of surgery
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World journal of surgery · Apr 2001
Distribution and functional significance of somatostatin receptors in malignant melanoma.
Malignant melanoma is a neuroendocrine tumor that contains somatostatin receptors (SSTRs). Adjuvant therapy for melanoma is limited. Because melanomas arise from neural crest cells, we sought to evaluate the distribution of SSTR subtypes found in these tumors and their functional significance by imaging with 111In-pentetreotide scintigraphy (OctreoScan). ⋯ The SSTR mRNA for SSTR2 appears to be transcribed into functional protein that binds 111In-pentetreotide in more than half of these patients. Although OctreoScan has limited sensitivity for localizing melanomas, tumors that can be imaged by OctreoScan may be amenable to adjuvant therapy with octreotide or targeted therapy with high-energy radioisotope-labeled octreotide. These studies clearly define melanoma as a neuroendocrine tumor, which may open new avenues for tumor control.
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Continuing advances in anesthesiology enable surgeons to perform more and more complex operations. Nowhere is this relation more important than for the patient undergoing thoracic surgery. Specialized anesthetic techniques including safe lung separation, the maintenance of oxygenation during selective one-lung ventilation, and effective postoperative analgesia allow procedures such as lung volume reduction surgery and lung transplantation to be performed routinely. This paper reviews modern clinical practices in the field of thoracic anesthesia.
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World journal of surgery · Jan 2001
Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma.
The objective of this study was to determine prospectively which risk factors require cardiac monitoring for blunt cardiac injury (BCI) following blunt chest trauma. All patients who sustained blunt chest trauma had an electrocardiogram (ECG) on admission to our urban level I trauma center. Those with ST segment changes, dysrhythmias, hemodynamic instability, history of cardiac disease, age > 55 years, or a need for general anesthesia within 24 hours (group 1) were admitted to the intensive care unit (ICU) for 24 hours where they were subjected to serial ECGs, creatinine phosphokinase (CPK) assays, and echocardiography (ECHO). ⋯ Patients who sustain blunt chest trauma with a normal ECG, normal blood pressure, and no dysrhythmias on admission require no further intervention for BCI. Patients with ST segment changes, dysrhythmias, or hypotension following blunt chest trauma should be monitored for 24 hours, as this subgroup occasionally requires further treatment for complications of BCI. ECHO adds nothing as a screening test.
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World journal of surgery · Jan 2001
Indicators of fatigue and of prolonged weaning from mechanical ventilation in surgical patients.
Indicators of weaning success have been tested primarily in patients who have been ventilated for short periods of time, and they may not be as accurate in cases where support has been required for longer than a few days. In patients requiring longer periods of support it is difficult to estimate the likelihood of successful liberation. Therefore we evaluated established weaning indices for their accuracy in surgical patients who required > or = 72 hours of mechanical ventilation. ⋯ By multivariate analysis, an RSBI of > 105 on the first day of weaning predicted prolonged weaning (hazard ratio 1.9; p = 0.03). After 72 hours of mechanical ventilation, clinical fatigue and successful liberation are not reliably predicted by standard indices of respiratory muscle strength and reserve. However, an RSBI of >105 observed once the patient is ready to wean is associated with prolonged weaning.
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World journal of surgery · Dec 2000
Upper airway obstruction in patients with goiter studies by flow volume loops and effect of thyroidectomy.
The patient with goiter and his or her physician frequently overlook symptoms of upper respiratory obstruction. Conventional radiology is the accepted method for detecting upper airway obstruction in these patients. Flow volume loops provide additional information on airflow dynamics. ⋯ Surgery resulted in normalization of all preoperative abnormal curves. The flow volume loop is a simple noninvasive method for detecting upper airway obstruction in patients with goiter. Abnormal upper airway dynamics are present in more patients with goiter than previously recognized, and relief of this obstruction should be an important aspect of thyroid surgery.