World journal of surgery
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World journal of surgery · Sep 2000
Bedside percutaneous tracheostomy: prospective evaluation of a modification of the current technique in 100 patients.
Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. ⋯ All complications were successfully managed without an operation by tube exchange (n = 3) or observation (n = 1); there was no procedure-related mortality. Forty patients were available for long-term follow-up (6-18 months after tracheostomy) by telephone; one had persistent hoarseness without respiratory difficulty. We concluded that bedside PDT is safe and easy to teach when performed with a technique that ensures correct instrumentation.
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The origins and development of the renal transplant program at the Peter Bent Brigham Hospital (now the Brigham and Women's Hospital) from the late 1940s to the present are reviewed. The program was initiated as a effort to understand hypertension as a cause of renal failure. The initial transplants were unmodified allogeneic grafts placed in the thigh, followed by extensive laboratory experiments on dogs. ⋯ In 1959 the first successful fraternal allogeneic graft was accomplished as part of a protocol utilizing total body irradiation and bone marrow replacement. Finally, with the development of immunosuppressive drugs, we were able to transplant a cadaveric kidney successfully in 1962. This was a major impetus in the study of organ transplantation worldwide, which currently involves kidneys, liver, heart, pancreas, heart/lung, and bone marrow.
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World journal of surgery · Jun 2000
ReviewOverview of modern management of patients with critical injury and severe sepsis.
Over the last 10 years there have been substantial changes in the issues confronting intensivists and surgeons caring for critically ill patients. A substantial increase in the number of elderly patients with surgical illness and complex co-morbidity has accompanied the increase in the proportion of elderly in populations in the developed world. This phenomenon has been seen particularly with sepsis. ⋯ Despite many advances in the care of critically ill patients with injury or sepsis, mortality, morbidity, and cost remain high; and nutritional support is frequently required. The duration and extent of the metabolic changes seen in response to critical surgical illness and intensive care treatments have become better characterized. Although some of the changes in body water and fat are modifiable, loss of large amounts of (functional) protein has been resistant to various strategies so far studied.
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World journal of surgery · May 2000
Comparative StudyComparison of the hemodynamic parameters of open and laparoscopic adrenalectomy for pheochromocytoma.
Laparoscopic adrenalectomy has gained widespread popularity for treating a variety of adrenal disorders including pheochromocytoma, but the effects of pneumoperitoneum on the hemodynamics of patients with catecholamine-secreting tumors are poorly understood. The goal of this study was to compare the effects of carbon dioxide pneumoperitoneum and tumor manipulation on the hemodynamic parameters in two groups of patients with sporadic pheochromocytomas less than 7 cm in size. Group 1 patients (n = 11) underwent lateral transabdominal laparoscopic adrenalectomy, and group 2 (n = 11) underwent adrenalectomy by the open anterior approach. ⋯ There were no conversions or complications in the laparoscopic group; one patient in group 2 developed an incisional hernia. Although laparoscopic adrenalectomy for pheochromocytoma is associated with a greater increase in mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure, the creation of pneumoperitoneum does not significantly change the cardiac index or left ventricle work index. Carbon dioxide pneumoperitoneum is well tolerated in patients with pheochromocytoma.
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The superficial position of thyroid and parathyroid glands facilitates the use of diagnostic ultrasound (US) as an imaging technique. Techniques of image acquisition and interpretation are described in detail. Size and morphology of glands can be defined easily. The most important use of US guided biopsy in relation to thyroid and parathyroid glands is to increase diagnostic accuracy.