World journal of surgery
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The imaging characteristics of diagnostic ultrasound (US) are determined by the ultrasonic properties of tissue. The velocity of propagation of US and the attenuation are the 2 most important parameters. These determine the frequency with which the tissues may be imaged, which in turn sets a fundamental limit on the axial and the lateral resolution. ⋯ Also, the velocity of propagation in different tissues varies and this can lead to deviation of the ultrasonic beam from the assumed direction of propagation. This breakdown in assumptions leads to the creation of artifacts that must be appreciated in the interpretation of ultrasonic images. For this reason skilled interpreters of ultrasonic images follow 3 golden rules: never make an interpretation on a single image; just because a feature is displayed do not consider that it is necessarily real; and just because a feature is not displayed do not consider that it is necessarily not there.
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World journal of surgery · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialVideo-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer.
We designed a prospective trial to determine the long-term prognosis of video-assisted thoracoscopic (VATS) lobectomy versus conventional lobectomy for patients with clinical stage IA (T1N0M0) lung cancer. Between January 1993 and June 1994, 100 consecutive patients with clinical stage IA non-small cell lung carcinoma underwent either conventional lobectomy through an open thoracotomy (open group; n = 52) or VATS lobectomy (VATS group; n = 48). Lymph node dissections were performed in a similar manner in both groups. ⋯ Two and one of the open and VATS group patients developed second primary cancers, respectively. The overall survival rates 5 years after surgery were 85% and 90% in the open and VATS groups, respectively (log-rank test, p = 0.74; generalized Wilcoxon test, p = 0.91). VATS lobectomy with lymph node dissection achieved an excellent 5-year survival, similar to that achieved by the conventional approach.
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World journal of surgery · Jan 2000
Comparative StudyOperative management of civilian rectal gunshot wounds: simpler is better.
Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. ⋯ In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.
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World journal of surgery · Jan 2000
Comparative StudyFate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease.
The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed; 65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) and 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0.0001). ⋯ Using Kaplan-Meier methods, the 10-year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%; p = 0.0001), whereas the 10-year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%; p = 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.
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World journal of surgery · Jan 2000
Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection.
Some patients are prone to persisting intraabdominal infection regardless of initial eradication of the source of infection. Our aim was to characterize patients who had to undergo relaparotomy for persisting abdominal sepsis using simple clinical parameters and to define those patients who are susceptible to benefit of aggressive surgical treatment by early and repeated reoperations to control multiple organ dysfunction syndrome (MODS) caused by ongoing intraabdominal infection. Persisting abdominal sepsis was the cause of death in all of our patients who had to undergo relaparotomy. ⋯ Our data show that timely relaparotomy provides the only surgical option that significantly improves outcome. However, aggressive surgical treatment has reached its limit in patients whose source of infection could not be controlled at the initial operation. To improve overall survival the decision to perform a relaparotomy on demand after an initially successful eradication of the source of infection must be made within 48 hr, at least before MODS emerges.