World journal of surgery
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World journal of surgery · Feb 1998
ReviewReflex sympathetic dystrophy: model of a severe regional inflammatory response syndrome.
The systemic inflammatory response syndrome (SIRS) and acute reflex sympathetic dystrophy syndrome (RSD) share clinical signs of severe inflammation, a protracted course, and a similar problem of impaired oxygen utilization. The difference is that SIRS patients have these signs and symptoms systemically and are severely ill in the intensive care unit (ICU), whereas acute RSD patients are in good health and their problems are limited to one extremity. Both conditions seem to be the result of an exaggerated inflammatory response. ⋯ It is hypothesized that this situation is exquisitely suitable for studying the pathophysiology of severe inflammatory responses in humans. Only a few patients are required to perform studies of, for example, oxygen metabolism and cytokine or oxygen radical production. Assessment methods may be utilized, such as nuclear magnetic resonance spectroscopy, which cannot easily be performed in ICU patients.
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World journal of surgery · Nov 1997
ReviewSurvival following orthotopic cardiac xenotransplantation between juvenile baboon recipients and concordant and discordant donor species: foundation for clinical trials.
It has been more than a decade since the last clinical trial of cardiac xenotransplantation in a newborn infant. Since that event, laboratory research at Loma Linda University has focused on survival studies of orthotopically xenografted juvenile baboon recipients. Both concordant and discordant donor species have been used. ⋯ Investigation of discordant (pig-to-baboon) host survival has focused on adsorption of naturally occurring xenoreactive antibody at the time of transplantation. This strategy, combined with pretransplant total lymphoid irradiation and both pre- and posttransplant immunosuppression, succeeded in preventing hyperacute rejection and resulted in survival of up to 24 days, thereby permitting observation of the delayed xenograft rejection phase. Data support consideration of additional clinical trials of concordant neonatal cardiac xenotransplantation and offer promise for the development of discordant xenotransplantation as an ultimate therapeutic resource.
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World journal of surgery · Jun 1997
Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion.
The objective of this study was to determine the morbidity associated with trocar and needle insertion for laparoscopic surgery and to identify risk factors for complications. Data from a prospectively collected database of all laparoscopic operations performed at a major teaching hospital over a 4-year period were analyzed. In 203 patients closed laparoscopy (Veress needle plus blind trocar insertion) was used to establish the pneumoperitoneum. ⋯ Age, gender, obesity, diabetes mellitus, previous abdominal surgery, and the specific procedure had no influence. In conclusion, gaining access to the peritoneal cavity for laparoscopic surgery may cause severe complications, most of which are related to the umbilical trocar. Although closed laparoscopy can be safely used, open laparoscopy is associated with a lower morbidity rate; therefore its utilization is recommended.
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World journal of surgery · Jun 1997
Clinical TrialPrevention of postoperative late kyphosis in Pott's disease by anterior decompression and intervertebral grafting.
A total of 185 patients with Pott's disease were operated on between 1973 and 1992. Anterior decompression by preserving the pleura (extrapleural approach) was the preferred method in the thoracic spine. In the lumbar spine the approach was retroperitoneal, and interbody fusion was performed in both for the thoracic and the lumbar regions. ⋯ The mean follow-up period was 7.5 years. Thirty-two of the cases were admitted to the clinic because of Pott's paraplegia: 19 of the cases recovered completely following anterior decompression; partial recovery was observed in 5 cases; but 3 cases did not recover. Various complications, including seven deaths, were observed in 42 of the cases.