World journal of surgery
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World journal of surgery · Mar 1999
Randomized Controlled Trial Clinical TrialThoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy.
The purpose of this study was to investigate whether thoracic epidural anesthesia (TEA) provides better postoperative pain relief and recovery than general anesthesia (GA) for modified radical mastectomy (MRM) surgery. Sixty-four patients rated as American Society of Anesthesiologists (ASA) 1 to 3 who underwent MRM surgery were included in the study. In TEA group patients, 2% lidocaine (15-20 ml) was administered via the epidural route as primary anesthesia, in conjunction with midazolam (5-10 mg) and fentanyl (<250 microg) for amnesia. ⋯ NT 53,806 +/- 2,817) (p = 0.0342) and anesthesia cost (NT 7,968 +/- 246 vs. NT 5,268 +/- 262) (p < 0.0001) are also significantly lower in the TEA group than the GA group. In conclusion, TEA provided better postoperative pain relief and recovery and lower cost than GA for MRM surgery.
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World journal of surgery · Feb 1999
Multicenter StudyUltrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group.
A prospective multicenter observational trial was performed to assess the performance and clinical benefit of ultrasonography of the appendix in the routine clinical examination. Included in the study were 2280 patients with acute abdominal pain from 11 surgical departments in Germany and Austria. Ultrasonography of the appendix was performed in 870 (38%) of the patients (range 16-85%). ⋯ With respect to single ultrasound scan findings, adequate sensitivity (44%) was achieved only with the target phenomen, not with the other criteria. There were no correlations between the ultrasound findings of the appendix and the diagnostic accuracy of the clinician, the negative appendectomy rate, or the perforated appendix rate. From the study it can be concluded that there is no proven clinical benefit of ultrasound scanning of the appendix in the routine clinical diagnosis.
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World journal of surgery · Feb 1999
Comparative StudyLong-term measurements of energy expenditure in severe burn injury.
The objective of this study was to evaluate resting energy expenditure (REE) in spontaneously breathing and artificially ventilated burn patients during the entire intensive care period. In 27 patients with 51 +/- 20% body surface area burned (BSAB) the REE was determined via indirect calorimetry. Three groups were formed according to the mortality prognosis index of Zawacki et al. ⋯ Expecting a stable clinical course in patients with a predicted mortality of <20% (group A), oral nutrition usually seems sufficient after a short period of artificial nutritional support (1 week). Patients with a predicted mortality of more than 20% have a complication-burdened clinical course and a prolonged period of ventilation (groups B and C). These patients need parenteral and enteral nutrition for at least 20 days after trauma to prevent severe malnutrition.
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World journal of surgery · Feb 1999
Comparative StudyDiagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis.
The clinical diagnosis of appendicitis needs to be improved, as up to 40% of explorations for suspected appendicitis are unnecessary. The use of body temperature and laboratory examinations as diagnostic aids in the management of these patients is controversial. The diagnostic power of these variables compared to that of the disease history and clinical findings is not well studied. ⋯ The leukocyte and differential WBC counts, C-reactive protein, rebound tenderness, guarding, and gender were independent predictors of appendicitis with a combined ROC area of 0. 93 for appendicitis. This showed that inflammatory variables contain important diagnostic information, especially with advanced appendicitis. They should therefore always be included in the diagnostic workup in patients with suspected appendicitis.
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World journal of surgery · Jan 1999
Randomized Controlled Trial Clinical TrialRecombinant human erythropoietin and hemoglobin concentration at operation and during the postoperative period: reduced need for blood transfusions in patients undergoing colorectal surgery--prospective double-blind placebo-controlled study.
In a double-blind placebo-controlled study we investigated the effect of recombinant human erythropoietin (r-HuEPO), on the perioperative hemoglobin concentration and the use of blood transfusions in patients undergoing elective colorectal surgery with a preoperative hemoglobin level