World journal of surgery
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As technology expands and health care resources become more limited, there is increasing pressure on surgeons to evaluate surgical procedures and technology to ensure they are effective. No longer is evidence from case series acceptable, and treatments must be evaluated in randomized controlled trials. ⋯ Many cite methodologic issues related to surgical issues as the reason for this, including concerns related to standardization of the surgical procedure, timing of surgical trials, difficulties with blinding of subjects and investigators, ethics of surgical trials, and patient and surgeon acceptance of surgical trials. These issues are discussed in this paper as are possible strategies to minimize their effect.
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The randomized clinical trial (RCT) is often referred to as the gold standard for the assessment of treatment efficacy. RCTs are receiving greater attention in the literature and higher priority by funding agencies than they have in the past. In this paper, the basic principles of clinical trial design are reviewed using examples from the neurosurgical literature. The importance of designing the trial to answer one question well is emphasized.
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World journal of surgery · Nov 1999
ReviewSurgery for chronic thromboembolic pulmonary hypertension.
The modern era of surgery for chronic thromboembolic pulmonary hypertension (CTEPH) began just over 10 years ago. Until that time pulmonary thromboendarterectomy (PTE) was performed infrequently and essentially at a single medical center (University of California at San Diego-UCSD). It posed a formidable technical challenge and was associated with both high operative mortality (> 20%) and excessive morbidity due to respiratory and multiorgan system failure. ⋯ Operative mortality rates have fallen, and postoperative complications have become less common. Although no longer simply an autopsy curiosity, CTEPH continues to be an underdiagnosed condition. Increased awareness and better diagnosis will lead to curative surgery in more patients worldwide.
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Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. ⋯ All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.
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World journal of surgery · Oct 1999
ReviewFemale genital mutilation: A global bug that should not cross the millennium bridge.
Female genital mutilation (FGM) has been practiced worldwide, clothed under the tradocultural term "circumcision." Indications for its practice include ensuring virginity, securing fertility, securing the economic and social future of daughters, preventing the clitoris from growing long like the penis, and purely as a "tradition." Outlawed only in the United Kingdom, Sweden, and Belgium, no law forbids it in most other countries. Classified into four identified types, the current perpetrators are mainly quacks, but trained medical personnel still connive at and encourage FGM. Early complications include hemorrhage, urinary tract infection, septicemia, and tetanus. ⋯ It should incur global abolition, the same way slave trade or Victorian chastity belts have done. We advocate that in medical communications the term "female genital mutilation" be used in place of "female circumcision." World leaders should include unacceptable cultural practices such as FGM in the "world summit" agenda. The year 1999 should be declared the year for global eradication of FGM.