World journal of surgery
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World journal of surgery · Mar 1993
Predicting postoperative fatigue: importance of preoperative factors.
Postoperative fatigue as defined by a 10-point scale (1 = fit, 10 = fatigued) was determined prospectively in 84 patients undergoing major surgery. Results from this scale correlated well with standard psychological assessment of fatigue (Profile of Mood States Questionnaire) (r = 0.767; p < 0.0001). Fatigue values were 3.46 +/- 0.19 arbitrary units (mean +/- SEM) preoperatively; and postoperatively they were 5.61 +/- 0.24 at day 7, 5.02 +/- 0.24 at day 14, 3.74 +/- 0.19 at day 28, and 2.77 +/- 0.18 at day 90. ⋯ The best predictor of postoperative fatigue was preoperative fatigue (r = 0.545; p = 0.001), with lesser correlations with diagnosis (especially cancer); preoperative weight, particularly total body protein (r = 0.317; p = 0.01); and weight loss (r = 0.29; p = 0.03), grip strength (r = 0.352; p = 0.01), and age (r = 0.267; p = 0.01). Postoperative fatigue was not correlated with preoperative anxiety, depression, or hostility, involuntary muscle function, gender, preoperative stress, or changes in total body protein or fat over the two postoperative weeks. It is concluded that patients who present for surgery already fatigued are the ones who are most likely to suffer from prolonged postoperative fatigue, particularly so if they are elderly, suffer from cancer, or have few extra reserves of body protein.
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Laparoscopic cholecystectomy has represented a potentially more morbid procedure than open cholecystectomy. Some of this morbidity has been due to complications associated with pneumoperitoneum. ⋯ Among 151 patients who underwent laparoscopic cholecystectomy using abdominal wall retraction there were no recognized adverse effects. Abdominal wall retraction enables the surgeon to minimize the risk of serious complications associated with pneumoperitoneum during laparoscopic cholecystectomy.
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World journal of surgery · Sep 1992
Optimal timing of elective indirect inguinal hernia repair in healthy children: clinical considerations for improved outcome.
Experience with several incarcerations that resulted in emergent surgery for children with known indirect inguinal hernias prompted this review to determine if there is an optimal time after hernia diagnosis during which elective repair should be undertaken to avoid incarceration. Over a 30 month period, 228 children less than 10 years of age underwent 303 indirect inguinal hernia repairs. They were analyzed for age, sex, interval between diagnosis and repair, predisposing conditions, major complications, and length of hospitalization. ⋯ Compared to children who underwent repair of a reducible indirect inguinal hernia, those with incarceration were more likely (p less than 0.05): 1) to have major complications (11% vs 0.6%), 2) to have a shorter interval between diagnosis and repair (26 vs 49 days), 3) to be younger (7.5 vs 25.6 mos), and 4) to require greater than 24 hours of hospitalization. Had children with reducible incarcerated indirect inguinal hernia been hospitalized and undergone repair 24 to 48 hours later, 83% of subsequent incarcerations would have been prevented. Furthermore, this experience supports the recommendation that for healthy children less than 10 years of age, indirect inguinal hernia repair should be performed on a semi-elective basis within 7 days of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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World journal of surgery · May 1992
Mandatory bicycle helmet use: experience in Victoria, Australia.
On July 1, 1990, the legislation requiring wearing of an approved bicycle (safety) helmet by all pedal cyclists, unless exempted, came into effect in Victoria, Australia. The paper describes the more important activities which paved the way for this initiative and presents some preliminary information about the effect of the legislation on wearing rates and head injuries. Since 1980 there has been promotion of helmet use through bicycle education in schools, mass media publicity, support by professional organizations and community groups, bulk purchase schemes, and government rebates for helmet purchases. ⋯ In the period after the legislation, with relatively little enforcement, these three groups have shown substantial increases in helmet use rates, rising to 70-90% in most cases. Preliminary data show that the numbers of bicyclists with a head injury have dropped in the period since the legislation came into effect. The possible contributions to this reduction, of less bicycle use and lower risk of head injury in an accident, are discussed.
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Major thermal injury is associated with extreme hypermetabolism and catabolism as the principal metabolic manifestations encountered following successful resuscitation from the shock phase of the burn injury. Substrate and hormonal measurements, indirect calorimetry, and nitrogen balance are biochemical metabolic parameters which are useful and more readily available biochemical parameters worthy of serial assessment for the metabolic management of burn patients. However, the application of stable isotopes with gas chromatography/mass spectroscopy and more recently, new immunoassays for growth factors and cytokines has increased our understanding of the metabolic manifestations of severe trauma. ⋯ Recent research investigations have revealed the importance of enteral feeding to enhance mucosal defense against gut bacteria and endotoxin. Similarly, research has demonstrated that many of the metabolic perturbations of burns and sepsis may be due, at least in part, to inflammatory cytokines. Investigation of their pathogenesis and mechanism of action both at a tissue and a cellular level offer important prospects for improved understanding and therapeutic control of the metabolic disorders of burn patients.