World journal of surgery
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World journal of surgery · Dec 1998
Effect of basic prehospital trauma life support program on cognitive and trauma management skills.
We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. ⋯ Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.
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World journal of surgery · Nov 1998
ReviewAcute cholangitis and pancreatitis secondary to common duct stones: management update.
Gallstones are found within the main bile duct (MBD) of 7% to 20% of patients undergoing cholecystectomy. MBD stones are the commonest cause of acute cholangitis and acute pancreatitis. Acute cholangitis is the result of infection superimposed on an obstructed biliary system and carries a high mortality rate if left untreated. ⋯ Initial treatment is supportive, although new agents designed to suppress the systemic inflammatory response are under development and have proved beneficial in clinical trials. Severe cases should be treated with systemic antibiotics and early removal of the obstructing stones by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Prophylactic cholecystectomy is recommended to prevent further episodes of gallstone pancreatitis.
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World journal of surgery · Oct 1998
CommentTranspelvic gunshot wounds: routine laparotomy or selective management?
Mandatory exploration is the standard method for managing patients with gunshot wounds to the abdomen and back. This policy is associated with a high incidence of unnecessary laparotomies and significant morbidity. Reports from our center have shown that a policy of selective management, based on clinical findings, is safe in such patients. ⋯ Clinical examination had a sensitivity of 100% and specificity of 71.4% in detecting the need for laparotomy. A policy of selective management is thus safe, even for patients who suffer gunshot wounds with a high likelihood for intraabdominal organ injury. Clinical examination, supported by additional studies in appropriate cases, is the main method of selecting patients for operation or nonoperative treatment.
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World journal of surgery · Oct 1998
Short-term outcome and predictors of adverse events following pulmonary thromboendarterectomy.
Pulmonary complications including hypoxemia, right heart failure, and prolonged ventilation may follow pulmonary thromboendarterectomy (PTE) performed via cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest. Seventeen adult patients have undergone PTE at the University of Maryland Medical System during the preceding 3 years. From these patients, clinical and hemodynamic parameters were tabulated pre-CPB, post-CPB, at admission to the intensive care unit (ICU), and prior to discontinuation of invasive monitoring in the ICU. ⋯ Pulmonary artery pressures and vascular resistance fall significantly after PTE. A lower post-CPB PVR and a relatively decreased (i.e., from pre-CPB values) CVP predict reduced length of postoperative ventilation but not of the hospital stay. Mortality appears increased in patients with a large body habitus.
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Bariatric surgery is the most effective method for treating patients with morbid obesity, and participation of the anesthesiologist in the treatment of these patients is more and more frequent. Therefore it is important for anesthesiologists to be familiar with anatomic and physiologic implications and the pharmacologic changes associated with obesity, so they can offer optimal perioperative treatment. The present study describes a series of 37 patients with an average body mass index of 50.3 kg/m2 who underwent bariatric surgery in a third-level teaching hospital in Mexico City. ⋯ Both general anesthesia and mixed anesthesia (peridural block plus light general anesthesia) were employed. The incidence of complications related to perioperative and anesthetic management was low. We discuss and propose protocols for the evaluation and management of airway and associated cardiorespiratory complications.